Efficacy and safety of short (≤6 months) versus prolonged (>6 months) dual antiplatelet therapy following percutaneous coronary intervention: a systematic review and meta-analysis
A Gasca, N Nelson, A Beltran, J Aldea, J Ruiz, B Gomez, L Cuevas, A CalderonAbstract
Background/Introduction
The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) remains uncertain, as therapy must balance ischemic protection against bleeding risk. While prolonged DAPT may enhance antithrombotic efficacy, shorter regimens have been proposed to improve safety.
Purpose
To compare the efficacy and safety of short (≤6 months) versus prolonged (>6 months) DAPT following PCI.
Methods
PubMed, Embase, and Cochrane Library were systematically searched from inception through November 27, 2025. Randomized controlled trials and observational cohort studies comparing short versus prolonged DAPT were included. Efficacy outcomes were all-cause mortality, cardiovascular mortality, major adverse cardiovascular events (MACE), and target-vessel revascularization (TVR). The primary safety outcome was bleeding. Pooled risk ratios (RRs) were calculated using random-effects models, with heterogeneity assessed by the I² statistic.
Results
Thirty-three studies (24 RCTs and 9 cohorts), including 86,676 patients, were analyzed. Short DAPT showed comparable efficacy to prolonged DAPT, with no significant differences in all-cause mortality, cardiovascular mortality, MACE, or TVR. Short DAPT significantly reduced bleeding events (RR 0.86, 95% CI 0.76–0.98; p=0.02) with no heterogeneity (I²=0%).
Conclusions
In patients undergoing PCI, ≤6 months of DAPT provides similar protection against ischemic events as >6 months, while significantly reducing bleeding. These findings support guideline-aligned strategies favoring shorter DAPT in appropriately selected patients, particularly those at higher bleeding risk, without compromising cardiovascular outcomes.OutcomesINFOGRAPHIC