Key result
Abbreviated DAPT lowers bleeding ~29% vs standard DAPT without increasing MACE.
Why the study?
The optimal duration of DAPT in patients at high bleeding risk undergoing PCI remains uncertain.
Does abbreviated DAPT reduce bleeding and prevent MACE in patients at high bleeding risk undergoing PCI?
Meta-Analysis (n=11,398)
Yes
Does abbreviated DAPT reduce bleeding and prevent MACE in patients at high bleeding risk undergoing PCI?
Relative Risk: 0.71 (95% CI 0.55–0.92)
p-value: p=.009
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.
Abbreviated DAPT reduces MCRB without increasing MACE; reinforces shorter regimens in high-bleeding-risk patients.
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.
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Zito et al. (2026) 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.
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