Key result
Short-term DAPT followed by P2Y12 monotherapy cuts clinically relevant bleeding ~52% with no mortality impact.
Why the study?
In ACS patients undergoing PCI, early aspirin withdrawal with P2Y12 inhibitor monotherapy after abbreviated DAPT may reduce bleeding, but concerns persist regarding ischaemic safety.
Does short-term DAPT (1–3 months) followed by P2Y12 inhibitor monotherapy reduce all-cause mortality and clinically relevant bleeding compared to standard-duration DAPT in patients with acute coronary syndrome undergoing PCI?
Meta-Analysis (n=30,873)
Randomized controlled trials
Does short-term DAPT (1–3 months) followed by P2Y12 inhibitor monotherapy reduce all-cause mortality and clinically relevant bleeding compared to standard-duration DAPT in patients with acute coronary syndrome undergoing PCI?
Short-term DAPT (1–3 months) followed by P2Y12 inhibitor monotherapy halves clinically relevant and major bleeding without significantly increasing ischaemic events or mortality in ACS patients undergoing PCI.
Background In acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), early aspirin withdrawal with P2Y12 inhibitor monotherapy after abbreviated dual antiplatelet therapy (DAPT) may reduce bleeding, but concerns persist regarding ischaemic safety. We synthesised randomised evidence using frequentist and Bayesian methods to quantify probabilities of benefit and harm. Methods Cochrane Library, Embase, PubMed, and Scopus were searched for randomised trials comparing short-term DAPT (1–3 months) followed by P2Y12 inhibitor monotherapy versus standard-duration DAPT after PCI for ACS. Frequentist and Bayesian random-effects meta-analyses were performed; Bayesian models were fitted using Markov chain Monte Carlo sampling. Co-primary outcomes were all-cause mortality and clinically relevant bleeding (trial-defined). Results are reported as odds ratios (OR) with 95% confidence intervals (CI) or credible intervals (CrI) and Bayesian probabilities of benefit. Results Ten trials (30,873 participants) were included. Short-term DAPT halved clinically relevant bleeding (OR 0.48, 95% CI 0.41 - 0.56; I2 = 0%; Bayesian probability of benefit 100%) and major bleeding (OR 0.48, 95% CI 0.34 - 0.68; I2 = 38.7%). All-cause mortality numerically favoured short-term DAPT but did not reach significance (OR 0.89; 95% CI 0.67 to 1.19; Bayesian probability of benefit 79.5%). No increase was observed in myocardial infarction (OR 1.08; 95% CI 0.85 to 1.39), stent thrombosis (OR 1.09; 95% CI 0.72 to 1.66), or stroke (OR 0.94; 95% CI 0.68 to 1.30). Net adverse clinical events favoured short-term DAPT (OR 0.73; 95% CI 0.58 to 0.93; Bayesian probability of benefit 99.7%). Conclusions Short-term DAPT followed by P2Y12 inhibitor monotherapy halves bleeding without significant increase in ischaemic events in ACS patients undergoing PCI. These findings support short-term DAPT as a bleeding avoidance strategy in appropriately selected patients.Outcome1Mortality
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Sreenivasan et al. (2026) conducted a meta-analysis in Acute coronary syndrome undergoing percutaneous coronary intervention (n=30,873). Short-term DAPT followed by P2Y12 inhibitor monotherapy vs. Standard-duration DAPT was evaluated on Co-primary outcomes: clinically relevant bleeding (trial-defined) and all-cause mortality (OR 0.48 (clinically relevant bleeding); OR 0.89 (all-cause mortality), 95% CI 0.41-0.56 (bleeding); 0.67-1.19 (mortality)). Short-term DAPT followed by P2Y12 monotherapy halved clinically relevant bleeding (OR 0.48; 95% CI 0.41-0.56) without significantly affecting all-cause mortality (OR 0.89; 95% CI 0.67-1.19).
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