Key result
Three-month DAPT cuts major and clinically relevant bleeding ~34% vs. standard DAPT in high-risk PCI.
Why the study?
Patients at high bleeding risk undergoing PCI face increased bleeding complications from long-term antiplatelet therapy, prompting the need to determine the optimal DAPT duration and strategy for this population.
Does shortened dual antiplatelet therapy (1-month or 3-month DAPT followed by monotherapy) reduce bleeding events without increasing major adverse cardiovascular events or mortality compared to standard 12-month DAPT in high bleeding risk patients undergoing PCI?
Meta-Analysis (n=15,391)
Yes
Does shortened dual antiplatelet therapy (1-month or 3-month DAPT followed by monotherapy) reduce bleeding events without increasing major adverse cardiovascular events or mortality compared to standard 12-month DAPT in high bleeding risk patients undergoing PCI?
Relative Risk: 0.66 (95% CI 0.44–0.99)
Absolute Event Rate: 3.7% vs 6.8%
In high bleeding risk patients undergoing PCI, a 3-month DAPT regimen followed by monotherapy significantly reduces major and clinically relevant bleeding by 34% without increasing ischemic events or mortality compared to standard 12-month DAPT.
Supports 3-month DAPT followed by monotherapy to cut bleeding in high-risk PCI patients; extends network evidence across 12 studies of 15,391 patients.
Patients undergoing percutaneous coronary intervention (PCI) require long-term antiplatelet therapy to prevent thrombotic events. However, those at high bleeding risk (HBR) face increased bleeding complications, prompting interest in shorter durations of dual antiplatelet therapy (DAPT). This study evaluates different DAPT durations and strategies to determine the optimal regimen for HBR patients. A systematic search of PubMed, Embase, and Cochrane databases up to May 2025 identified clinical trials comparing antiplatelet strategies in HBR patients, including randomized controlled trials and cohort studies. Primary outcomes included major adverse cardiovascular events (MACE), all-cause mortality, cardiovascular mortality, and bleeding events. Twelve studies (2009–2022) comprising 15,391 patients were analyzed. Compared to standard DAPT, a 3-month DAPT followed by monotherapy significantly reduced major and clinically relevant bleeding (RR: 0.66, 95% CrI: 0.44–0.99) and major bleeding (RR: 0.70, 95% CrI: 0.51–0.97). No significant differences were observed between 1-month and 3-month DAPT. A 3-month DAPT followed by ticagrelor monotherapy showed a trend toward reduced bleeding (RR: 0.65, 95% CrI: 0.42–1.00), though not statistically significant. In HBR patients, compared with the standard 12-month DAPT, the 3-month DAPT followed by monotherapy significantly reduced the risk of bleeding, indicating a favorable safety profile of the shorter regimens (Fig. 1). Monotherapy choice after DAPT discontinuation appears to yield similar outcomes. Shortened DAPT durations should be considered for HBR patients undergoing PCI.
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Nie et al. (2026) conducted a meta-analysis in High bleeding risk patients undergoing percutaneous coronary intervention (PCI) (n=15,391). 3-month dual antiplatelet therapy (DAPT) followed by monotherapy vs. Standard 12-month dual antiplatelet therapy (DAPT) was evaluated on Composite of major and clinically relevant bleeding (RR 0.66, 95% CI 0.44-0.99). Three-month DAPT followed by monotherapy significantly reduced major and clinically relevant bleeding (RR 0.66, 95% CrI 0.44-0.99) compared to standard DAPT in high bleeding risk PCI patients.
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