Key result
One-month DAPT followed by P2Y12 monotherapy cuts NACE ~42% versus 12-month DAPT.
Why the study?
Bleeding risk has driven interest in shorter durations of dual antiplatelet therapy after PCI, but the optimal duration balancing efficacy and safety is unclear.
Does short-duration DAPT (1, 3, or 6 months) followed by P2Y12 inhibitor monotherapy improve net adverse clinical events and bleeding compared to 12-month DAPT in patients undergoing PCI with drug-eluting stents?
Meta-Analysis (n=33,832)
Does short-duration DAPT (1, 3, or 6 months) followed by P2Y12 inhibitor monotherapy improve net adverse clinical events and bleeding compared to 12-month DAPT in patients undergoing PCI with drug-eluting stents?
Relative Risk: 0.58 (95% CI 0.45–0.75)
p-value: p=< 0.0001
Short-duration DAPT (1 or 3 months) followed by P2Y12 inhibitor monotherapy provides a better balance of reduced bleeding without compromising ischemic protection compared to standard 12-month DAPT after PCI.
Short DAPT followed by P2Y12 monotherapy reduces bleeding without excess ischemia after PCI; reinforces de-escalation as standard in selected patients.
Background and Aims Coronary artery disease is commonly managed with percutaneous coronary intervention (PCI) followed by dual antiplatelet therapy (DAPT). However, bleeding risk has driven interest in shorter DAPT durations. This network meta-analysis evaluates the efficacy and safety of different DAPT durations after PCI. Methods PubMed, EuropePMC, and Scopus were searched for randomized controlled trials (RCTs) comparing short-duration (1, 3, or 6 months) versus 12-month DAPT after PCI with drug-eluting stents (DES). Outcomes included net adverse clinical events (NACE), major adverse cardiovascular events (MACE), bleeding, mortality, myocardial infarction, stroke, revascularization, and stent thrombosis. Risk ratios were pooled using random-effects pairwise and network meta-analysis. Results Sixteen RCTs (33,832 patients) were included. One-month (RR 0.58; 95% CI 0.45–0.75; p < 0.0001) and 3-month (RR 0.70; 95% CI 0.58–0.84; p = 0.0002) DAPT followed by P2Y12 inhibitor monotherapy reduced NACE compared with 12-month DAPT. Clinically relevant bleeding was reduced with P2Y12 monotherapy after 1-month (RR 0.40; 95% CI 0.27–0.60; p < 0.0001) and 3-month DAPT (RR 0.62; 95% CI 0.51–0.76; p < 0.0001), with major bleeding lowest at 1 month (RR 0.31; 95% CI 0.20–0.48; p < 0.0001) and reduced at 3 months (RR 0.52; 95% CI 0.37–0.74; p = 0.0002). No significant differences were observed in other outcomes. Ranking favored P2Y12 inhibitor-based strategies, particularly the 1-month regimen. Conclusion Short-duration DAPT followed by P2Y12 inhibitor monotherapy, particularly the 1-month regimen, provides the most favorable balance between reduced bleeding and preserved ischemic protection compared with standard 12-month DAPT after PCI.Figure 1.Forest Plot of Network Meta-Analysis for Clinical Outcomes
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Artanti et al. (2026) conducted a meta-analysis in Coronary artery disease (n=33,832). Short-duration (1- or 3-month) dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy vs. 12-month dual antiplatelet therapy was evaluated on Net adverse clinical events (NACE) (RR 0.58, 95% CI 0.45-0.75, p=< 0.0001). One-month dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy significantly reduced net adverse clinical events compared with 12-month DAPT (RR 0.58; 95% CI 0.45-0.75; P<0.0001).
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