What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Post-percutaneous coronary intervention (PCI) (n=153797). Intervention: Short-term and de-escalation DAPT strategies vs. Standard DAPT. Primary outcome: Bleeding (BARC 2, 3, or 5) in men receiving short DAPT followed by aspirin (RR 0.44, 95% CI 0.27-0.73).

What does this research mean for the field?

Short DAPT followed by aspirin reduces bleeding in men but not women after PCI, while de-escalation to clopidogrel provides the lowest bleeding risk and best net clinical profile in women. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess sex-specific outcomes of different DAPT strategies after PCI to inform personalized treatment approaches.

April 24, 2026Open Access

Sex-specific efficacy and safety of short-term and de-escalation DAPT strategies after PCI: a network meta-analysis

HLHao-Yun LoMemorial Hospital SCSu-Kiat ChuaFu Jen Catholic University JLJ K LeeNational Taiwan University

Key Result

Short DAPT followed by aspirin reduced bleeding in men (RR 0.44) but not women, while de-escalation to clopidogrel provided the lowest bleeding risk and best net clinical profile in women.

Key Points

To assess sex-specific outcomes of different DAPT strategies after PCI to inform personalized treatment approaches.
Conducted a network meta-analysis of randomized controlled trials.
Analyzed sex-stratified outcomes for various DAPT strategies against standard DAPT.
Evaluated primary outcomes including major adverse cardiovascular events, bleeding, and net adverse clinical events.
No DAPT strategy was superior for major adverse cardiovascular events in men.
In men, short DAPT followed by aspirin significantly reduced bleeding (RR 0.44) and P2Y12i monotherapy also reduced bleeding (RR 0.52).
In women, de-escalation to clopidogrel showed the lowest bleeding risk and favorable outcomes for net adverse clinical events.

Study Design

Type

Meta-Analysis (n=153,797)

Structured PICO

Do alternative DAPT strategies (short-term or de-escalation) improve MACE, bleeding, or NACE compared to standard DAPT differently in men versus women after percutaneous coronary intervention?

Population

153,797 patients (115,223 men and 38,574 women) undergoing percutaneous coronary intervention (PCI) across 25 randomized controlled trials. 11 studies exclusively enrolled patients with acute coronary syndrome (ACS), and 12 studies included a mixed population of chronic coronary syndrome and ACS.

Intervention

Alternative dual antiplatelet therapy (DAPT) strategies, categorized as: guided de-escalation (directed by platelet function testing or CYP2C19 genotyping), short DAPT (1-3 months) followed by aspirin or P2Y12 inhibitor monotherapy, de-escalation to clopidogrel, or de-escalation to reduced-dose P2Y12 inhibitor.

Comparator

Standard dual antiplatelet therapy (DAPT).

Outcome

Major adverse cardiovascular events (MACE: composite of all-cause death, cardiac death, myocardial infarction, ischemic stroke, definite stent thrombosis, or clinically driven target vessel revascularization), bleeding (Bleeding Academic Research Consortium [BARC] types 2, 3, or 5), and net adverse clinical events (NACE: composite of MACE and bleeding).composite

Sex-based differences exist in optimal post-PCI DAPT strategies, with short DAPT followed by monotherapy robustly reducing bleeding in men, while de-escalation to clopidogrel optimizes safety and net clinical outcomes in women.

Main Result

Effect estimate: RR 0.44 (95% CI 0.27-0.73)

Limitations

Findings should be considered hypothesis-generating pending confirmatory evidence from dedicated prospective trials evaluating sex-specific antiplatelet strategies after PCI.

Abstract

Abstract Background Sex differences in thrombotic and bleeding risks after percutaneous coronary intervention (PCI) are well established, yet it remains uncertain whether the efficacy and safety of modern dual antiplatelet therapy (DAPT) strategies differ between men and women. Objectives This study aimed to compare sex-specific outcomes of contemporary short-term and de-escalation DAPT strategies to guide individualized post-PCI management. Methods A network meta-analysis of randomized controlled trials reporting sex-stratified outcomes for alternative DAPT strategies versus standard DAPT was performed. Strategies were categorized as standard DAPT, guided de-escalation, short DAPT followed by aspirin or P2Y12 inhibitor (P2Y12i) monotherapy, de-escalation to clopidogrel, or de-escalation to reduced-dose P2Y12i. The primary outcomes were major adverse cardiovascular events (MACE), bleeding, and net adverse clinical events (NACE). Results A total of 25 trials including 115,223 men and 38,574 women were analyzed. For MACE, no strategy was superior in men, while de-escalation to clopidogrel showed a favorable trend in women. In men, short DAPT followed by aspirin (risk ratio RR 0.44, 95% confidence interval CI 0.27–0.73) or P2Y12 inhibitor monotherapy (RR 0.52, 95% CI 0.39–0.70) reduced bleeding, whereas this benefit was not observed in women (P for sex difference = 0.015). De-escalation to clopidogrel provided the lowest bleeding risk and the most favorable NACE profile in women. Conclusions Sex-based differences exist in the optimal DAPT strategy following PCI, with short DAPT followed by monotherapy robustly reducing bleeding risk in men, while de-escalation to clopidogrel showed the most favorable profile for bleeding and net clinical outcomes in women. However, this finding should be considered hypothesis-generating pending confirmatory evidence, and underscores the need for dedicated prospective trials evaluating sex-specific antiplatelet strategies after PCI.

Perguntar à IA

Bookmark

View Full Paper