Key result
Short-term DAPT (≤3 months) reduced the risk of major bleeding (RR 0.67; 95% CI 0.48-0.94; P=0.02) compared with 12 months of DAPT in patients undergoing PCI, without increasing death or ischemia.
Why the study?
Prolonging DAPT increases bleeding risk, and the optimal duration of DAPT after PCI remains controversial.
Does short-term DAPT (3 months or less) reduce bleeding without increasing ischemic events compared to standard 12-month DAPT in patients undergoing PCI?
Meta-Analysis (n=38,479)
Does short-term DAPT (3 months or less) reduce bleeding without increasing ischemic events compared to standard 12-month DAPT in patients undergoing PCI?
Relative Risk: 0.92 (95% CI 0.8–1.06)
p-value: p=0.25
Short-term DAPT (1-3 months) reduces bleeding risk without increasing ischemic or mortality risk compared to standard 12-month DAPT in patients undergoing PCI.
Supports shorter DAPT post-PCI to cut bleeding; extends RCT data confirming no ischemic or mortality trade-off.
Dual antiplatelet therapy (DAPT) is the basis of preventing stent thrombosis and ischemic events after percutaneous coronary intervention (PCI), but prolonging the duration of DAPT will increase the risk of bleeding. The optimal duration of DAPT after PCI remains controversial at present. The purpose of this meta-analysis was to investigate the efficacy and safety of short-term DAPT in patients undergoing PCI. PubMed, Embase, Cochrane and Web of science from inception to September 2019 were systematically searched. Randomized controlled trials were included to compare short term (3 months or less) with a standard 12-months DAPT in patients undergoing PCI. Random effect model and fixed effect model wereused to calculate the risk ratio (RR) and 95% confidence interval (CI) of each endpoint. This meta-analysis included 38479 patients undergoing PCI from 8 randomized clinical trials. No difference was observed in the risk of all-cause death (RR 0.92, 95% CI 0.80–1.06, P = 0.25), cardiovascular death (RR 0.88, 0.69–1.12, P = 0.29), myocardial infarction (RR 1.05, 0.94–1.19, P = 0.38), definite or probable stent thrombosis (RR 1.05, 0.80–1.36, P = 0.73), and stroke (RR 1.02, 0.80–1.30, P = 0.89) between short term and standard DAPT. The short-term DAPT could reduce the risk of major bleeding (RR 0.67, 0.48–0.94, P = 0.02) and any bleeding (RR 0.63, 0.48-0.82, P = 0.0005) compared with 12 months of DAPT. In conclusion, the short-term DAPT can reduce the risk of bleeding compared with standard DAPT, without increasing the risk of death or ischemia (Registered by PROSPERO, CRD42020153881).
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Zhang et al. (2020) conducted a meta-analysis in Percutaneous coronary intervention (n=38,479). Short-term dual antiplatelet therapy vs. Standard 12-months dual antiplatelet therapy was evaluated on all-cause death (RR 0.92, 95% CI 0.80-1.06, p=0.25). Short-term DAPT (≤3 months) reduced the risk of major bleeding (RR 0.67; 95% CI 0.48-0.94; P=0.02) compared with 12 months of DAPT in patients undergoing PCI, without increasing death or ischemia.
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