Key result
Short-duration DAPT plus P2Y12 monotherapy cuts major bleeding ~42% vs standard DAPT without increasing MACE.
Why the study?
After contemporary PCI, short-duration DAPT followed by P2Y12 monotherapy may reduce bleeding without increasing ischemia compared with standard DAPT.
Does short-duration DAPT (1-3 months) followed by P2Y12 monotherapy reduce major bleeding without increasing major adverse cardiovascular events compared to standard DAPT in patients undergoing contemporary PCI?
Meta-Analysis (n=48,732)
Randomized controlled trials
Does short-duration DAPT (1-3 months) followed by P2Y12 monotherapy reduce major bleeding without increasing major adverse cardiovascular events compared to standard DAPT in patients undergoing contemporary PCI?
Short-duration DAPT (1-3 months) followed by P2Y12 monotherapy significantly reduces major bleeding and net adverse clinical events without increasing ischemic risk compared to standard DAPT after contemporary PCI.
Answers are grounded in this paper and cite their sources.
Short DAPT plus P2Y12 monotherapy may be preferred post-PCI to reduce bleeding; reinforces RCT evidence for de-escalation without ischemic harm.
Introduction: After contemporary percutaneous coronary intervention (PCI), short-duration dual antiplatelet therapy (DAPT) followed by P2Y12 monotherapy may reduce bleeding without increasing ischemia versus standard DAPT. Methods: A systematic search of MEDLINE, Embase, and Cochrane Central identified randomized controlled trials. Bayesian network meta-analysis was performed in R using the ‘meta’ package. Risk of bias was assessed with ROB 2.0. Random-effects models estimated major bleeding and major adverse cardiovascular events. Results: The Bayesian network meta-analysis included 12 randomized controlled trials (48,732 patients). Short-duration DAPT (1-3 months) followed by P2Y12 monotherapy significantly reduced major bleeding versus standard DAPT (OR 0.58, 95% CrI 0.42-0.79) without increasing major adverse cardiovascular events (MACE; OR 0.94, 95% CrI 0.78-1.13). Short-duration DAPT ranked highest for bleeding safety (SUCRA 0.92) and similar for MACE (SUCRA 0.54). Myocardial infarction (OR 0.97, 95% CrI 0.79-1.19), stent thrombosis (OR 0.89, 95% CrI 0.61-1.28), all-cause death (OR 0.91, 95% CrI 0.70-1.17), and stroke (OR 1.02, 95% CrI 0.74-1.38) showed no significant differences. Net adverse clinical events favored short-duration DAPT (OR 0.69, 95% CrI 0.53-0.89). Node-splitting indicated no inconsistency. ROB 2.0 showed low bias in 8 trials. Ticagrelor monotherapy yielded the lowest bleeding risk (OR 0.51, 95% CrI 0.34-0.72). Conclusion: Short-duration DAPT followed by P2Y12 monotherapy significantly reduces major bleeding without increasing ischemic events compared to standard DAPT after contemporary PCI. This strategy offers an optimal balance of safety and efficacy, supporting abbreviated DAPT as a preferred approach, particularly in high-bleeding-risk patients.
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Ajay et al. (2026) conducted a meta-analysis in Contemporary percutaneous coronary intervention (PCI) (n=48,732). Short-duration dual antiplatelet therapy (DAPT) followed by P2Y12 monotherapy vs. Standard dual antiplatelet therapy (DAPT) was evaluated on Major bleeding (OR 0.58, 95% CI 0.42-0.79). Short-duration DAPT (1-3 months) plus P2Y12 monotherapy reduced major bleeding vs standard DAPT (OR 0.58, 95% CrI 0.42-0.79) without increasing MACE (OR 0.94, 95% CrI 0.78-1.13).
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