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This study evaluates the efficacy and safety of different durations of dual antiplatelet therapy (DAPT) in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). The findings suggest that shorter durations of DAPT followed by potent P2Y12 inhibitor monotherapy can reduce major bleeding without increasing the risk of major adverse cardiac and cerebrovascular events (MACCE). However, the optimal duration to minimize MACCE remains uncertain, with 3 months of DAPT followed by P2Y12 inhibitors emerging as a potentially favorable strategy.
Study Design:
- Participants: 35,326 patients with ACS (mean age 63.1 years; 76.3% male; 32.1% with STEMI).
- Interventions: Comparison of DAPT durations (1 month, 3 months, 6 months) followed by P2Y12 inhibitors or aspirin, against the conventional 12 months of DAPT.
- Databases Searched: MEDLINE, Embase, Cochrane, LILACS.
- Analysis: Bayesian network meta-analysis with risk ratios (RR) and 95% credible intervals (CrI).
Key Findings:
- Major Bleeding: 1 month of DAPT followed by P2Y12 inhibitors significantly reduced major bleeding (RR, 0.47; 95% CrI, 0.26-0.74) compared to 12 months of DAPT.
- MACCE: No significant difference in MACCE between different DAPT strategies, though 3 months of DAPT followed by P2Y12 inhibitors was ranked best for reducing MACCE (RR, 0.85; 95% CrI, 0.56-1.21).
- Safety: The safety of stopping aspirin in patients taking clopidogrel remains unclear, as most patients in the study were on ticagrelor.
HCN Medical Memo
This study highlights the potential benefits of shorter DAPT durations followed by potent P2Y12 inhibitor monotherapy in reducing major bleeding without increasing MACCE. Clinicians should consider individual patient risk profiles when determining the optimal DAPT duration, especially given the uncertainty around stopping aspirin in those on clopidogrel.
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