# Comparison of Short-Term DAPT and Long-Term DAPT on the Prognosis of PCI Patients: A Meta-Analysis of Randomized Controlled Trials

## TL;DR

Short-term dual antiplatelet therapy after heart procedures is safer than long-term therapy and just as effective, even for patients with acute coronary syndrome.

## Contribution

This study provides a meta-analysis showing short-term DAPT is safer without compromising effectiveness compared to long-term DAPT after PCI.

## Key findings

- Short-term DAPT reduces major and any bleeding risks compared to long-term DAPT.
- Short-term DAPT followed by monotherapy further lowers bleeding risks without increasing ischemic events.
- No significant differences in death rates were observed between short-term and long-term DAPT strategies.

## Abstract

Dual antiplatelet therapy (DAPT) is the primary medication for patients after
percutaneous coronary intervention (PCI). However, the best DAPT duration is still controversial.
This systematic review and meta-analysis aims to assess the safety and effectiveness of short-term (3–6 months)
DAPT compared to long-term (12 months) DAPT.

We searched PubMed, Embase, Cochrane Library,
and Web of Science systematically for all the randomized controlled trials (RCTs)
which compared the different strategies for
DAPT in patients undergoing PCI within ten years prior to January 2021. Major
bleeding and any bleeding were identified as the safe endpoints. All causes of
death, cardiac death, myocardial infarction, definite/probable stent thrombosis,
target vessel revascularization, and stroke were identified as the efficacy
endpoints. The hazard ratio (HR) and 95% confidence interval (CI) in each study
were abstracted.

Overall,
11 trials and 24,242 patients were included in this meta-analysis with 15-month
median follow-up time. Short-term DAPT was related to reduced risks of major
bleeding (HR 0.65, 95% CI 0.48–0.89) and any bleeding (HR 0.64, 95% CI
0.53–0.79). No obvious differences in any of the other endpoints were observed. In
acute coronary syndrome (ACS) patients with drug-eluting stents (DES), short-term
compared with long-term DAPT was related to a decreased risk of major bleeding
(HR 0.57, 95% CI 0.37–0.87) without significant increasing in the risks of any
bleeding and ischemic endpoints. Furthermore, short-term DAPT followed by
P2Y12 receptor inhibitor monotherapy appreciably lowered the risk of major
bleeding (HR 0.64, 95% CI 0.42–0.96) and any bleeding (HR 0.58, 95% CI
0.36–0.93). There were no obvious differences concerning death between the different strategies for DAPT.

After PCI with DES, short-term DAPT is safer than long-term DAPT, and is not
inferior in effectiveness, even in ACS patients. P2Y12 receptor inhibitor
monotherapy following short-term DAPT is also related to a decreased risk of
bleeding and may be an alternative anti-platelet
strategy.