Key result
Abbreviated DAPT followed by P2Y12 monotherapy cuts bleeding ~52% vs standard DAPT without increasing MACCE.
Why the study?
Prolonged aspirin exposure after PCI in ACS patients increases bleeding risk, prompting evaluation of early aspirin discontinuation.
Does abbreviated DAPT followed by P2Y12 inhibitor monotherapy reduce bleeding and maintain efficacy compared to standard DAPT in patients undergoing PCI for ACS?
Meta-Analysis (n=18,794)
Does abbreviated DAPT followed by P2Y12 inhibitor monotherapy reduce bleeding and maintain efficacy compared to standard DAPT in patients undergoing PCI for ACS?
Relative Risk: 1.03 (95% CI 0.82–1.3)
Absolute Event Rate: 3.38% vs 3.16%
p-value: p=0.78
Early aspirin withdrawal after PCI for ACS reduces bleeding but increases the risk of stent thrombosis without affecting overall MACCE.
Supports abbreviated DAPT with P2Y12 monotherapy to reduce bleeding in eligible patients; extends de-escalation evidence from prior RCTs.
Introduction Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the standard antiplatelet strategy following percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS). Prolonged aspirin exposure, however, increases the risk of bleeding, prompting evaluation of early aspirin discontinuation. Material and Methods We performed a systematic search of RCTs comparing abbreviated DAPT followed by P2Y12 inhibitor monotherapy with DAPT in this population. Six RCTs involving 18,794 patients were included. Results This strategy showed no significant difference compared with DAPT in the risk of major adverse cardiac and cerebrovascular events, all-cause death, cardiovascular death, myocardial infarction, and stroke. It was associated with significantly lower risk of clinically relevant bleeding (RR = 0.48), major bleeding (RR = 0.44), and net adverse events (RR = 0.80). However, the risk of stent thrombosis was higher with this strategy (RR = 1.83). Conclusions Abbreviated DAPT followed by P2Y12 monotherapy maintains efficacy and lowers bleeding, with increased stent thrombosis risk.
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Mahmud et al. (2026) conducted a meta-analysis in Acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) (n=18,794). Abbreviated DAPT followed by P2Y12 inhibitor monotherapy vs. Standard dual antiplatelet therapy (DAPT) was evaluated on Major adverse cardiac and cerebrovascular events (MACCE) (RR 1.03, 95% CI 0.82-1.30, p=0.78). Abbreviated DAPT followed by P2Y12 inhibitor monotherapy showed no significant difference in MACCE (RR 1.03) but significantly reduced clinically relevant bleeding (RR 0.48) compared to standard DAPT.
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