Key result
Short-duration DAPT plus P2Y12 inhibitor monotherapy reduces major bleeding ~39% vs. standard DAPT.
Why the study?
The optimal duration of dual antiplatelet therapy after PCI with the best risk-benefit ratio remains uncertain.
Meta-Analysis (n=29,089)
Yes
Answers are grounded in this paper and cite their sources.
Supports early aspirin cessation post-PCI to reduce bleeding; extends RCT evidence for P2Y12 monotherapy safety.
BACKGROUND: The optimal duration of dual antiplatelet therapy is a matter of ongoing research. Clinical studies are assessing the optimal duration with the most favourable risk to benefit ratio. The efficacy of P2Y12 receptor inhibitors comparable to aspirin in preventing recurrent ischaemic events in patients with coronary artery diseases. OBJECTIVES: To investigate the outcomes of short-duration dual antiplatelet therapy after PCI with early discontinuation of aspirin while maintaining patients on P2Y12 inhibitor through systematic review and meta-analysis of available literature. METHODS: We systematically searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov. We included randomized controlled studies that measured clinical outcomes of efficacy (mortality and ischaemic events) and safety (bleeding) of short and standard-duration dual antiplatelet therapy. The protocol of this study was registered in the international prospective register of systematic reviews PROSPERO registry (CRD42020171468). RESULTS: Four randomized controlled trials were included; GLOBAL LEADERS, SMARTCHOICE, STOPDAPT-2, and TWILIGHT. The total number of patients was 29,089. The safety outcomes showed a significant reduction in major bleeding events with short-duration dual antiplatelet therapy; the risk ratio was 0.61 (95% CI 0.38-0.99; z=2,00, p=0.05). There was no difference between short and standard-duration dual antiplatelet therapy regarding efficacy outcomes (all- cause death, major adverse cardiovascular events, myocardial infarction, stroke, and stent thrombosis). CONCLUSION: Short-duration dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy after PCI is a feasible option and can be adopted, especially in patients with a high risk of bleeding.
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AL-Obaidi et al. (2021) conducted a meta-analysis in Coronary artery disease post percutaneous coronary intervention (PCI) (n=29,089). Short-duration dual antiplatelet therapy (≤ 3 months) followed by P2Y12 inhibitor monotherapy vs. Standard duration dual antiplatelet therapy (12 months aspirin and P2Y12 inhibitor) was evaluated on Major bleeding events (BARC type 3 or 5 bleeding) (RR 0.61, 95% CI 0.38-0.99, p=0.05). Short-duration dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy significantly reduced major bleeding events by 39% (RR 0.61) compared to standard-duration therapy without compromising efficacy outcomes.
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