Dual Antiplatelet Therapy Duration in Patients at High Bleeding Risk
Andrea Zito, Antonio Landi, Deepak L. Bhatt, Shao-Liang Chen, Giuseppe De Luca, Anna Franzone, Hyeon-Cheol Gwon, Jeehoon Kang, Joo-Yong Hahn, Sung-Jin Hong, Yangsoo Jang, Byeong-Keuk Kim, Hyo-Soo Kim, Takeshi Kimura, Roxana Mehran, Kyoung-Woo Park, Philippe Gabriel Steg, Gregg W. Stone, Pascal Vranckx, Stephan Windecker, Marco ValgimigliImportance
The optimal duration of dual antiplatelet therapy (DAPT) in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) remains uncertain.
Objectives
To evaluate the safety and efficacy of abbreviated DAPT durations in patients at HBR undergoing PCI.
Data Sources
PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to October 26, 2025.
Study Selection
Randomized clinical trials (RCTs) comparing abbreviated (ie, 1- to 3-month) vs standard (ie, 6- to 12-month) DAPT durations in patients at HBR without an indication for oral anticoagulation.
Data Extraction and Synthesis
A pairwise meta-analysis was performed to compare abbreviated (ie, 1-month to 3-month) vs standard (ie, ≥6-month) DAPT durations. A frequentist network meta-analysis was performed to compare 1-month, 3-month, and standard DAPT.
Main Outcomes and Measures
The coprimary safety and efficacy end points were major or clinically relevant nonmajor bleeding (MCRB) and major adverse cardiovascular events (MACE; ie, a composite of cardiovascular death, myocardial infarction, or stroke).
Results
A total of 14 RCTs encompassing 11 398 patients at HBR (mean [range] age, 74.7 [68.6-80.0] years; 39.1% female and 60.9% male) were included. Compared with standard DAPT, abbreviated DAPT was associated with lower MCRB (risk ratio [RR], 0.71; 95% CI, 0.55-0.92;
Conclusions and Relevance
In this systematic review and meta-analysis, for patients at HBR undergoing PCI, abbreviated DAPT was associated with a lower risk of bleeding and, at least for 3-month regimens, was not associated with an increase in fatal or nonfatal ischemic cardiovascular or cerebrovascular events compared with standard 6- to 12-month DAPT.