OPTIMAL DURATION OF DUAL ANTIPLATELET THERAPY AFTER PERCUTANEOUS CORONARY INTERVENTION: A NETWORK META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Abstract

Coronary artery disease is commonly managed with percutaneous coronary intervention (PCI) followed by dual antiplatelet therapy (DAPT). However, bleeding risk has driven interest in shorter DAPT durations. This network meta-analysis evaluates the efficacy and safety of different DAPT durations after PCI. PubMed, EuropePMC, and Scopus were searched for randomized controlled trials (RCTs) comparing short-duration (1, 3, or 6 months) versus 12-month DAPT after PCI with drug-eluting stents (DES). Outcomes included net adverse clinical events (NACE), major adverse cardiovascular events (MACE), bleeding, mortality, myocardial infarction, stroke, revascularization, and stent thrombosis. Risk ratios were pooled using random-effects pairwise and network meta-analysis. Sixteen RCTs (33,832 patients) were included. One-month (RR 0.58; 95% CI 0.45–0.75; p < 0.0001) and 3-month (RR 0.70; 95% CI 0.58–0.84; p = 0.0002) DAPT followed by P2Y12 inhibitor monotherapy reduced NACE compared with 12-month DAPT. Clinically relevant bleeding was reduced with P2Y12 monotherapy after 1-month (RR 0.40; 95% CI 0.27–0.60; p < 0.0001) and 3-month DAPT (RR 0.62; 95% CI 0.51–0.76; p < 0.0001), with major bleeding lowest at 1 month (RR 0.31; 95% CI 0.20–0.48; p < 0.0001) and reduced at 3 months (RR 0.52; 95% CI 0.37–0.74; p = 0.0002). No significant differences were observed in other outcomes. Ranking favored P2Y12 inhibitor-based strategies, particularly the 1-month regimen. Short-duration DAPT followed by P2Y12 inhibitor monotherapy, particularly the 1-month regimen, provides the most favorable balance between reduced bleeding and preserved ischemic protection compared with standard 12-month DAPT after PCI.Figure 1.Forest Plot of Network Meta-Analysis for Clinical Outcomes