Dual Antiplatelet Therapy Duration in Patients at High Bleeding Risk
Year: 2026
Type: article
Study designs: Systematic Review, Meta-Analysis
Abstract: Importance: 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; P = .009) and major bleeding (RR, 0.76; 95% CI, 0.59-0.99; P = .04). The risks of MACE (RR, 0.97; 95% CI, 0.81-1.16; P = .76) and its individual components did not differ between abbreviated and standard regimens. An increased risk of MACE was observed with 1-month vs 3-month DAPT in the single trial comparing these regimens, but the network estimate was nonsignificant (RR, 1.28; 95% CI, 0.96-1.72). 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.
Source: JAMA Cardiology
Authors: 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 Valgimigli
Institutions: Università Cattolica del Sacro Cuore, Fondazione Poliambulanza Istituto Ospedaliero, Ente Ospedaliero Cantonale, Istituto Cardiocentro Ticino, Icahn School of Medicine at Mount Sinai, Nanjing First Hospital, Nanjing Medical University, University of Messina, Azienda Ospedaliera Universitaria Policlinico "G. Martino", University of Naples Federico II, Samsung Medical Center, Sungkyunkwan University, Seoul National University, Seoul National University Hospital, Yonsei University Health System, CHA University, CHA University Gangnam Medical Center, Yonsei University, Severance Hospital, Hirakata Kohsai Hospital, Inserm, Université Paris Cité, Assistance Publique – Hôpitaux de Paris, Laboratoire de Recherche Vasculaire Translationnelle, Hôpital Bichat-Claude-Bernard, Jessa Hospital, Hasselt University, University of Bern, University Hospital of Bern, Università della Svizzera italiana
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7165779051