Key result
Extended clopidogrel-based DAPT cuts stent thrombosis ~92%, while ticagrelor monotherapy best minimizes major bleeding.
Why the study?
Optimal antiplatelet therapy after PCI with DES requires balancing thrombotic protection and bleeding risk, but the comparative effectiveness of current oral antiplatelet strategies remains uncertain.
Does the choice of oral antiplatelet strategy (such as shortened DAPT with P2Y12 monotherapy or extended DAPT) reduce major bleeding and stent thrombosis in patients undergoing PCI with a drug-eluting stent?
Meta-Analysis (n=110,035)
Does the choice of oral antiplatelet strategy (such as shortened DAPT with P2Y12 monotherapy or extended DAPT) reduce major bleeding and stent thrombosis in patients undergoing PCI with a drug-eluting stent?
In patients undergoing PCI with DES, ticagrelor monotherapy best reduces major bleeding and extended clopidogrel-based DAPT best prevents stent thrombosis, while clopidogrel monotherapy after prolonged DAPT may offer a balanced risk-benefit profile.
Extended DAPT markedly reduces stent thrombosis; confirms its superiority over ticagrelor monotherapy for ischemic protection in high-risk patients.
Background: Optimal antiplatelet therapy after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) requires balancing thrombotic protection and bleeding risk, but the comparative effectiveness of current strategies remains uncertain. Aims: To evaluate the risk–benefit profile of oral antiplatelet strategies after PCI with DES, focusing on major bleeding and stent thrombosis. Methods: A network meta-analysis of randomised and observational studies was conducted. Strategies included standard or extended dual antiplatelet therapy (DAPT), shortened DAPT followed by monotherapy and P2Y12 inhibitor-based monotherapy. Outcomes were analysed using a random-effects model and ranked with p-scores. Evidence certainty was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Thirty studies involving 110,035 patients were included. Ticagrelor monotherapy ranked highest for reducing major bleeding, whereas extended DAPT provided the greatest protection against stent thrombosis, with clopidogrel-based therapy beyond 12 months ranking highest (RR 0.08; 95% CI [0.01–0.52]; p-score=0.94). Notably, clopidogrel monotherapy after prolonged DAPT demonstrated a relatively balanced profile across both outcomes. However, no strategy was consistently optimal and most estimates showed wide CIs. Conclusion: Antiplatelet strategies after PCI with DES involve a clear trade-off between bleeding and thrombotic risk. Clopidogrel monotherapy after prolonged DAPT may offer a balanced approach, although findings should be interpreted cautiously due to limited precision and consistency.
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Suryono et al. (2026) conducted a meta-analysis in Patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) (n=110,035). Oral antiplatelet strategies (standard/extended DAPT, shortened DAPT followed by monotherapy, P2Y12 inhibitor monotherapy) vs. Alternative oral antiplatelet strategies was evaluated on Major bleeding and stent thrombosis (RR 0.08, 95% CI 0.01-0.52). Clopidogrel-based extended DAPT (>12 months) ranked highest for reducing stent thrombosis (RR 0.08; 95% CI 0.01-0.52), while ticagrelor monotherapy ranked highest for reducing major bleeding.
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