Abbreviated DAPT (1-3 months) lowered major or clinically relevant nonmajor bleeding (RR 0.71; 95% CI 0.55-0.92; P=.009) without increasing MACE (RR 0.97; 95% CI 0.81-1.16; P=.76) vs standard DAPT.
Meta-Analysis (n=11,398)
Yes
Does abbreviated DAPT reduce bleeding and prevent MACE in patients at high bleeding risk undergoing PCI?
In patients at high bleeding risk undergoing PCI, an abbreviated 1- to 3-month DAPT strategy reduces bleeding without increasing ischemic events compared to a standard 6- to 12-month strategy.
Relative Risk: 0.71 (95% CI 0.55–0.92)
p-value: p=.009
Importance: The optimal duration of dual antiplatelet therapy (DAPT) in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) remains uncertain. Objectives: To evaluate the safety and efficacy of abbreviated DAPT durations in patients at HBR undergoing PCI. Data Sources: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to October 26, 2025. Study Selection: Randomized clinical trials (RCTs) comparing abbreviated (ie, 1- to 3-month) vs standard (ie, 6- to 12-month) DAPT durations in patients at HBR without an indication for oral anticoagulation. Data Extraction and Synthesis: A pairwise meta-analysis was performed to compare abbreviated (ie, 1-month to 3-month) vs standard (ie, ≥6-month) DAPT durations. A frequentist network meta-analysis was performed to compare 1-month, 3-month, and standard DAPT. Main Outcomes and Measures: The coprimary safety and efficacy end points were major or clinically relevant nonmajor bleeding (MCRB) and major adverse cardiovascular events (MACE; ie, a composite of cardiovascular death, myocardial infarction, or stroke). Results: A total of 14 RCTs encompassing 11 398 patients at HBR (mean range age, 74.7 68.6-80.0 years; 39.1% female and 60.9% male) were included. Compared with standard DAPT, abbreviated DAPT was associated with lower MCRB (risk ratio RR, 0.71; 95% CI, 0.55-0.92; P = .009) and major bleeding (RR, 0.76; 95% CI, 0.59-0.99; P = .04). The risks of MACE (RR, 0.97; 95% CI, 0.81-1.16; P = .76) and its individual components did not differ between abbreviated and standard regimens. An increased risk of MACE was observed with 1-month vs 3-month DAPT in the single trial comparing these regimens, but the network estimate was nonsignificant (RR, 1.28; 95% CI, 0.96-1.72). Conclusions and Relevance: In this systematic review and meta-analysis, for patients at HBR undergoing PCI, abbreviated DAPT was associated with a lower risk of bleeding and, at least for 3-month regimens, was not associated with an increase in fatal or nonfatal ischemic cardiovascular or cerebrovascular events compared with standard 6- to 12-month DAPT.
This large meta-analysis in JAMA Cardiology provides strong evidence that abbreviated DAPT (1-3 months) in high bleeding risk PCI patients reduces bleeding without increasing ischemic events, likely influencing clinical practice guidelines.
Zito et al. (Wed,) conducted a meta-analysis in High bleeding risk undergoing percutaneous coronary intervention (n=11,398). Abbreviated dual antiplatelet therapy (DAPT) vs. Standard DAPT (6- to 12-month) was evaluated on Major or clinically relevant nonmajor bleeding (MCRB) (RR 0.71, 95% CI 0.55-0.92, p=.009). Abbreviated DAPT (1-3 months) lowered major or clinically relevant nonmajor bleeding (RR 0.71; 95% CI 0.55-0.92; P=.009) without increasing MACE (RR 0.97; 95% CI 0.81-1.16; P=.76) vs standard DAPT.