Key result
Short DAPT post-PCI cuts bleeding ~14% vs prolonged DAPT with comparable ischemic efficacy.
Why the study?
The optimal duration of dual antiplatelet therapy (DAPT) after PCI remains uncertain, requiring a balance between ischemic protection from prolonged regimens and improved bleeding safety from shorter regimens.
Does short (≤6 months) dual antiplatelet therapy reduce bleeding while maintaining efficacy against ischemic events compared to prolonged (>6 months) dual antiplatelet therapy in patients undergoing percutaneous coronary intervention?
Meta-Analysis (n=86,676)
Does short (≤6 months) dual antiplatelet therapy reduce bleeding while maintaining efficacy against ischemic events compared to prolonged (>6 months) dual antiplatelet therapy in patients undergoing percutaneous coronary intervention?
In patients undergoing PCI, ≤6 months of DAPT provides comparable ischemic protection to >6 months of DAPT while significantly reducing bleeding risk by 14%.
Short DAPT reduces bleeding without increasing ischemic events; confirms prior RCTs and supports abbreviated regimens after PCI.
Background/Introduction The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) remains uncertain, as therapy must balance ischemic protection against bleeding risk. While prolonged DAPT may enhance antithrombotic efficacy, shorter regimens have been proposed to improve safety. Purpose To compare the efficacy and safety of short (≤6 months) versus prolonged (>6 months) DAPT following PCI. Methods PubMed, Embase, and Cochrane Library were systematically searched from inception through November 27, 2025. Randomized controlled trials and observational cohort studies comparing short versus prolonged DAPT were included. Efficacy outcomes were all-cause mortality, cardiovascular mortality, major adverse cardiovascular events (MACE), and target-vessel revascularization (TVR). The primary safety outcome was bleeding. Pooled risk ratios (RRs) were calculated using random-effects models, with heterogeneity assessed by the I² statistic. Results Thirty-three studies (24 RCTs and 9 cohorts), including 86,676 patients, were analyzed. Short DAPT showed comparable efficacy to prolonged DAPT, with no significant differences in all-cause mortality, cardiovascular mortality, MACE, or TVR. Short DAPT significantly reduced bleeding events (RR 0.86, 95% CI 0.76–0.98; p=0.02) with no heterogeneity (I²=0%). Conclusions In patients undergoing PCI, ≤6 months of DAPT provides similar protection against ischemic events as >6 months, while significantly reducing bleeding. These findings support guideline-aligned strategies favoring shorter DAPT in appropriately selected patients, particularly those at higher bleeding risk, without compromising cardiovascular outcomes.OutcomesINFOGRAPHIC
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Gasca et al. (2026) conducted a meta-analysis in Patients undergoing percutaneous coronary intervention (PCI) (n=86,676). Short dual antiplatelet therapy (≤6 months) vs. Prolonged dual antiplatelet therapy (>6 months) was evaluated on Bleeding (primary safety outcome); efficacy outcomes included all-cause mortality, cardiovascular mortality, MACE, and TVR (RR 0.86, 95% CI 0.76-0.98, p=0.02). Short DAPT (≤6 months) post-PCI significantly reduced bleeding compared to prolonged DAPT (>6 months) (RR 0.86, 95% CI 0.76-0.98; p=0.02) with comparable ischemic efficacy.
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