Work

Efficacy and safety of dual antiplatelet therapy de-escalation in East Asian individuals following percutaneous coronary intervention for acute coronary syndrome: a systematic review and meta-analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: BACKGROUND: East Asian patients with acute coronary syndrome (ACS) are more prone to bleeding complications than Western populations under comparable antithrombotic regimens. This pattern presents a considerable obstacle to the routine use of intensive dual antiplatelet therapy (DAPT) undergoing percutaneous coronary intervention (PCI). Consequently, the effectiveness and safety of DAPT de-escalation strategies tailored to this particular group of patients remain inadequately defined. METHODS: An extensive search of both Chinese and English literature databases was performed up to June 2025 to locate cohort studies and randomized controlled trials assessing the effectiveness and safety of de-escalating DAPT in East Asian individuals diagnosed with ACS. The primary outcomes included major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke, and bleeding outcomes, with bleeding classified according to Bleeding Academic Research Consortium (BARC) criteria. Meta-analytical methods were applied using either fixed-effects or random-effects models, depending on data suitability. RESULTS: A total of nine studies were included in the analysis, consisting of five RCTs and four cohort studies, encompassing 10,263 patients overall. Compared to standard DAPT, the de-escalation approach was significantly linked to lower risks of BARC type 1 bleeding (RR = 0.52; 95% CI: 0.32–0.86; p = 0.011), BARC type ≥ 2 bleeding (RR = 0.47; 95% CI: 0.37–0.60; p < 0.001), and BARC type ≥ 3 events (RR = 0.61; 95% CI: 0.40–0.94; p = 0.026). Nonetheless, the comparison between de-escalation and standard regimens revealed no statistically meaningful difference in MACE risk (RR = 0.91; 95% CI: 0.70–1.19; p = 0.497). This result remained stable across the separate elements comprising the MACE composite outcome. CONCLUSION: Among East Asian patients with ACS, implementing a DAPT de-escalation strategy lowers bleeding risk without elevating ischemic events, suggesting a potentially favorable safety profile in East Asian patients. Further validation by RCTs is warranted.

Source: BMC Cardiovascular Disorders

DOI: 10.1186/s12872-026-05527-z