Abbreviated dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials
Abstract Background Dual antiplatelet therapy (DAPT), combining aspirin and a P2Y12 receptor inhibitor, is a standard post-percutaneous coronary intervention (PCI) treatment to reduce thrombosis and ischemic events. However, the optimal DAPT duration remains unclear, with concerns about bleeding ris...
Saved in:
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-04-01
|
| Series: | BMC Cardiovascular Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12872-025-04765-x |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850206561242185728 |
|---|---|
| author | Hamidreza Soleimani Elaheh Karimi Mehrdad Mahalleh Fatemeh Jodeiri Entezari Ali Nasrollahizadeh Amir Nasrollahizadeh Hamed Rafiee Parvin Kalhor Karim M. Al-Azizi Luis H. Paz Rios Wilbert S. Aronow Andrew P. Ambrosy Kaveh Hosseini |
| author_facet | Hamidreza Soleimani Elaheh Karimi Mehrdad Mahalleh Fatemeh Jodeiri Entezari Ali Nasrollahizadeh Amir Nasrollahizadeh Hamed Rafiee Parvin Kalhor Karim M. Al-Azizi Luis H. Paz Rios Wilbert S. Aronow Andrew P. Ambrosy Kaveh Hosseini |
| author_sort | Hamidreza Soleimani |
| collection | DOAJ |
| description | Abstract Background Dual antiplatelet therapy (DAPT), combining aspirin and a P2Y12 receptor inhibitor, is a standard post-percutaneous coronary intervention (PCI) treatment to reduce thrombosis and ischemic events. However, the optimal DAPT duration remains unclear, with concerns about bleeding risks associated with long-term potent P2Y12 inhibitors. This systematic review and meta-analysis investigates the safety and efficacy of shortened DAPT regimens. Methods A comprehensive search of PubMed, Scopus, and EMBASE identified randomized controlled trials (RCTs) comparing conventional DAPT (≥ 12 months) and abbreviated DAPT (≤ 3 months) post-PCI. Primary outcomes were 1-year all-cause mortality and bleeding, assessed using the Bleeding Academic Research Consortium (BARC) classification. Secondary outcomes included cardiovascular mortality, non-fatal myocardial infarction (MI), stroke, and major adverse cardiovascular events (MACE). Risk of bias was assessed with the Cochrane tool, and meta-analyses used random-effects models. Results Forty studies involving 54,233 participants were included. Abbreviated DAPT significantly reduced all-cause mortality (RR: 0.90, 95%CI: 0.82–0.98) and bleeding (BARC 3 or 5: RR: 0.77, 95%CI: 0.60–0.97). No significant differences were observed in cardiovascular mortality, stroke, non-fatal MI, revascularization, or in-stent thrombosis. Subgroup analyses showed lower mortality with 1-month DAPT and reduced bleeding in patients with high bleeding risk, acute coronary syndrome (ACS), and complex PCI. Conclusions Abbreviated DAPT post-PCI is associated with lower all-cause mortality and bleeding without compromising ischemic protection, supporting its use in specific patient populations. Individualized DAPT durations should be considered to balance bleeding and ischemic risks. |
| format | Article |
| id | doaj-art-1023b8354ff74e9fb8a857d33005f863 |
| institution | OA Journals |
| issn | 1471-2261 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj-art-1023b8354ff74e9fb8a857d33005f8632025-08-20T02:10:46ZengBMCBMC Cardiovascular Disorders1471-22612025-04-0125111910.1186/s12872-025-04765-xAbbreviated dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trialsHamidreza Soleimani0Elaheh Karimi1Mehrdad Mahalleh2Fatemeh Jodeiri Entezari3Ali Nasrollahizadeh4Amir Nasrollahizadeh5Hamed Rafiee6Parvin Kalhor7Karim M. Al-Azizi8Luis H. Paz Rios9Wilbert S. Aronow10Andrew P. Ambrosy11Kaveh Hosseini12Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesTehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesTehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesTehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesTehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesTehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesTehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesTehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesDepartment of Cardiology, Baylor Scott and White The Heart HospitalDivision of Cardiology, Rooney Heart InstituteDepartments of Cardiology and Medicine, Westchester Medical Center and New York Medical CollegeDepartment of Cardiology, Kaiser Permanente San Francisco Medical CenterTehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical SciencesAbstract Background Dual antiplatelet therapy (DAPT), combining aspirin and a P2Y12 receptor inhibitor, is a standard post-percutaneous coronary intervention (PCI) treatment to reduce thrombosis and ischemic events. However, the optimal DAPT duration remains unclear, with concerns about bleeding risks associated with long-term potent P2Y12 inhibitors. This systematic review and meta-analysis investigates the safety and efficacy of shortened DAPT regimens. Methods A comprehensive search of PubMed, Scopus, and EMBASE identified randomized controlled trials (RCTs) comparing conventional DAPT (≥ 12 months) and abbreviated DAPT (≤ 3 months) post-PCI. Primary outcomes were 1-year all-cause mortality and bleeding, assessed using the Bleeding Academic Research Consortium (BARC) classification. Secondary outcomes included cardiovascular mortality, non-fatal myocardial infarction (MI), stroke, and major adverse cardiovascular events (MACE). Risk of bias was assessed with the Cochrane tool, and meta-analyses used random-effects models. Results Forty studies involving 54,233 participants were included. Abbreviated DAPT significantly reduced all-cause mortality (RR: 0.90, 95%CI: 0.82–0.98) and bleeding (BARC 3 or 5: RR: 0.77, 95%CI: 0.60–0.97). No significant differences were observed in cardiovascular mortality, stroke, non-fatal MI, revascularization, or in-stent thrombosis. Subgroup analyses showed lower mortality with 1-month DAPT and reduced bleeding in patients with high bleeding risk, acute coronary syndrome (ACS), and complex PCI. Conclusions Abbreviated DAPT post-PCI is associated with lower all-cause mortality and bleeding without compromising ischemic protection, supporting its use in specific patient populations. Individualized DAPT durations should be considered to balance bleeding and ischemic risks.https://doi.org/10.1186/s12872-025-04765-xAcute coronary syndromeDual antiplatelet therapyP2Y12 receptor inhibitorPercutaneous coronary intervention |
| spellingShingle | Hamidreza Soleimani Elaheh Karimi Mehrdad Mahalleh Fatemeh Jodeiri Entezari Ali Nasrollahizadeh Amir Nasrollahizadeh Hamed Rafiee Parvin Kalhor Karim M. Al-Azizi Luis H. Paz Rios Wilbert S. Aronow Andrew P. Ambrosy Kaveh Hosseini Abbreviated dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials BMC Cardiovascular Disorders Acute coronary syndrome Dual antiplatelet therapy P2Y12 receptor inhibitor Percutaneous coronary intervention |
| title | Abbreviated dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials |
| title_full | Abbreviated dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials |
| title_fullStr | Abbreviated dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials |
| title_full_unstemmed | Abbreviated dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials |
| title_short | Abbreviated dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials |
| title_sort | abbreviated dual antiplatelet therapy in patients undergoing percutaneous coronary intervention a systematic review and meta analysis of randomized controlled trials |
| topic | Acute coronary syndrome Dual antiplatelet therapy P2Y12 receptor inhibitor Percutaneous coronary intervention |
| url | https://doi.org/10.1186/s12872-025-04765-x |
| work_keys_str_mv | AT hamidrezasoleimani abbreviateddualantiplatelettherapyinpatientsundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT elahehkarimi abbreviateddualantiplatelettherapyinpatientsundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT mehrdadmahalleh abbreviateddualantiplatelettherapyinpatientsundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT fatemehjodeirientezari abbreviateddualantiplatelettherapyinpatientsundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT alinasrollahizadeh abbreviateddualantiplatelettherapyinpatientsundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT amirnasrollahizadeh abbreviateddualantiplatelettherapyinpatientsundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT hamedrafiee abbreviateddualantiplatelettherapyinpatientsundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT parvinkalhor abbreviateddualantiplatelettherapyinpatientsundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT karimmalazizi abbreviateddualantiplatelettherapyinpatientsundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT luishpazrios abbreviateddualantiplatelettherapyinpatientsundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT wilbertsaronow abbreviateddualantiplatelettherapyinpatientsundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT andrewpambrosy abbreviateddualantiplatelettherapyinpatientsundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT kavehhosseini abbreviateddualantiplatelettherapyinpatientsundergoingpercutaneouscoronaryinterventionasystematicreviewandmetaanalysisofrandomizedcontrolledtrials |