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Abbreviated dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials

BMC Cardiovascular Disorders volume 25, Article number: 343 (2025) Cite this article

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.

Peer Review reports

Introduction

The combination of aspirin and a P2Y12 receptor inhibitor, also known as dual antiplatelet therapy (DAPT), is the cornerstone of post-percutaneous coronary intervention (PCI) medical treatment administered to reduce the risk of thrombosis and other ischemic cardiovascular events [1]. However, the optimal duration of post-PCI DAPT is still under question. Current guidelines emphasize a patient-centered approach in selecting the duration of DAPT, balancing ischemic and bleeding risks based on individual patient profiles. While traditional recommendations favored 12 months of DAPT for ACS and at least 6 months for non-ACS PCI, emerging evidence and expert consensus support more flexible, risk-adapted durations [1,2,3,4]. The long-term use of potent P2Y12 inhibitors has been lately associated with a higher risk of bleeding [5, 6], casting doubt on the traditional DAPT strategies.

The safety and efficacy of DAPT de-escalation strategies have recently been investigated in randomized clinical trials (RCTs). In these regimens, the administration of aspirin plus P2Y12 inhibitors is downgraded to monotherapy with a P2Y12 inhibitor after 1 to 3 months [7,8,9,10,11,12]. Despite evidence in favor of short duration vs conventional DAPT in terms of fewer side effects and non-inferior efficacy, the evidence is still limited. Herein, we conducted a systematic review and meta-analysis of RCTs to shed light on safety and efficacy of shortened DAPT following PCI.

Methods

This systematic review and network meta-analysis followed the guidelines set out by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [13]. The protocol for this analysis was submitted to the PROSPERO online database and assigned a registration ID CRD42024543394.

Search strategy, selection criteria and data extraction

A comprehensive and organized search strategy was developed and carried out in PubMed, Scopus, and EMBASE from the beginning of their records up to January 2024 (Supplemental Table 1). Additionally, reference lists of relevant studies and reviews were examined for possible inclusions.

All Randomized Controlled Trials (RCTs) that compared the following two DAPT strategies in patients who had undergone PCI were included: conventional DAPT strategy (defined as continuing DAPT for at least 12 months followed by single anti-platelet treatment, either Aspirin or a P2Y12inhibitor, for the remainder of the follow-up) and abbreviated DAPT strategy (defined as up to maximum 3 months of DAPT followed by single anti-platelet treatment, either Aspirin or a P2Y12inhibitor, for the remainder of the follow-up). Studies involving timing strategies that did not match our previously mentioned criteria, observational and non-comparative studies, conference abstracts, reviews, non-English language, and animal studies were excluded. Studies with pre-specified subgroup analysis of RCTs that met the inclusion criteria were also eligible for inclusion.

Data collection and extraction process involved importing the findings of the systematic search into Rayyan web application (Rayyan, Cambridge, MA, United States of America) [14]. Two researchers (H.R. and E.K), separately examined the titles and abstracts of the obtained citations to determine which studies were eligible. The full texts of the selected citations were then individually assessed by the same two investigators. Discrepancies were resolved through discussion and consensus, with a third reviewer consulted when necessary. This process ensured a high level of consistency and accuracy in the extracted data.

In the next step, data from the citations that remained on the final list after the full text review were collected by the same two authors, who also cross-verified each other’s work to ensure consistency. Data from these studies were extracted using a standardized data collection sheet in Microsoft Excel (Microsoft Corporation, Redmond, WA, United States). The extracted data encompassed various variables, including author names, publication years, study designs, sample sizes, DAPT strategy durations, type of P2Y12 inhibitor used, follow-up duration, participant ages, gender distribution, type of subgroup analyzed in the study, and data regarding primary and secondary outcomes.

Outcomes

Our primary efficacy outcome was 1-year all-cause mortality as it was reported in more studies and it had the least amount of missing data. For primary safety outcome we evaluated data regarding bleeding in the first follow-up year as reported based on Bleeding Academic Research Consortium (BARC) classification. In short, BARC classification divides bleeding episodes into 5 distinct types where each type categorizes bleeding according to its severity and type of therapeutic actions needed (with type 1 being the least serious type of bleeding and type 5 being the most serious and life-threatening type) [15]. Secondary efficacy outcomes included cardiovascular mortality, non-fatal Myocardial Infarction (MI), stroke, target vessel revascularization, any coronary revascularization, in-stent thrombosis and composite MACE outcomes (with different definitions across different studies, but mostly consisting of composite of all-cause mortality, non-fatal MI, need for revascularization and stroke).

Risk of bias assessment

Version 2.0 of Cochrane Risk of Bias Assessment Tool for Randomized Trials (RoB2) was used to assess the quality of the RCT included in the study [16]. Two authors (F.J and M.M) independently assessed and assigned stars to each included study in each of the five domains of RoB2 questionnaire, all disagreements in this step were resolved by the way of consensus.

Statistical analysis

All outcomes reported in our study were binary, therefore, they were reported as percentages (number) and in order to combine treatment effect estimates, the relative risk for each outcome was calculated and then pooled using the inverse-variance weighting method. As it was anticipated that significant heterogeneity would be present between studies, a random effects model was utilized to estimate and compare treatment effect sizes. Heterogeneity was objectively assessed using the Higgins & Thompson’s I2 statistic and Cochrane’s Q [17, 18]. We used the Egger test to formally investigate reporting bias. This test examines the symmetry of funnel plots. If the test results were not statistically significant, it was determined that the risk of reporting bias was minimal [19]. For outcomes where there were more than 10 studies available, funnel plots were also drawn. To perform sensitivity analysis of our outcome results, we gathered data from pre-specified subgroup studies of each main trial and pooled sub-group analysis was performed. Also, leave one out analysis was performed to uncover any source of heterogeneity. Meta-regression for evaluation of primary outcome was performed for four baseline characteristics that had the least amount of missing data. All statistical analyses were conducted using the R software (R for Windows, version 4.1.3, Vienna, Austria) [20] and R Studio version 1.1.463 (Posit PBC, Boston, MA, United States), utilizing packages tidyverse, meta and robvis [20,21,22].

Results

Study outlines and baseline characteristics

A total of 4893 studies were identified through a systematic search. After removing duplicates, 3184 studies underwent title/abstract evaluation, and 86 full-texts were further assessed for eligibility. A total of 40 studies that met all inclusion criteria of this meta-analysis were finally included; of these, 12 studies were RCTs comparing abbreviated DAPT with conventional DAPT (Fig. 1). The remaining were studies with pre-specified subgroup analysis of the included RCTs, focusing on analyzing reference cohorts regarding gender, age, body mass index (BMI), ACS, diabetes mellitus (DM), complex PCI, high bleeding risk (HBR) status, and chronic kidney disease (CKD). Additionally, subgroup analyses were performed specifically for patients with HBR and those without.

Fig. 1
figure 1

PRISMA flow diagram

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All studies were conducted between 2012 and 2024, comprising 54,233 participants (27,136 randomized to conventional DAPT and 27,097 randomized to abbreviated DAPT) with a mean age of 61.45 years, and 75% were male. Six trials compared 3-month DAPT with 12-month DAPT [11, 23,24,25,26,27], four trials compared 1-month DAPT with 12-month DAPT [28,29,30,31], one trial compared 3-month DAPT with 15-month DAPT [32], and one trial compared 1-month Prasugrel monotherapy with 1-month DAPT [12]. All trials were multi-centric, with follow-up periods ranging from 1 month in the STOPDAPT-3 trial [12] to 5 years in the STOPDAPT-2 trial [31]. The baseline characteristics and main findings of the included studies are summarized in Table 1.

Table 1 Characteristics of included randomized controlled trials
Full size table

Quality assessment

We assessed the methodological quality of the included studies using the Cochrane Collaborative Assessment Tool. Our studies were generally assessed as having a moderate risk of bias overall. Supplemental Fig. 1 shows the methodological quality assessment results of each included RCT.

All-cause mortality

Thirteen studies reported the rate of all-cause mortality. Abbreviated DAPT significantly reduced all-cause mortality compared to conventional DAPT (RR: 0.90, 95%CI: 0.82–0.98, I2: 0%) (Fig. 2A). Subgroup analysis by DAPT duration indicated that 1-month DAPT was associated with slightly lower all-cause mortality compared to conventional DAPT (RR: 0.89, 95%CI: 0.80–0.99, I2: 0%), while no significant difference was found between 3-month DAPT and conventional DAPT (RR: 0.91, 95%CI: 0.75–1.11, I2: 0%) (Fig. 2B). Further subgroup analyses based on demographics (gender, BMI, elderly), comorbidities (ACS, CKD, DM), PCI complexity, and HBR status did not reveal significant differences (Fig. 2C). The subgroup analysis for HBR vs. non-HBR patients showed that abbreviated DAPT was associated with no statistically significant difference in mortality risk between HBR and non-HBR patients (HBR: RR = 1.11, 95% CI: 0.84–1.48 vs. non-HBR: RR = 0.87, 95% CI: 0.80–0.94) (Supplemental Fig. 3).

Fig. 2
figure 2

All-cause and Cardiovascular Mortality Outcomes: A Forest plots representing the risk of all-cause mortality after abbreviated DAPT vs. conventional DAPT; B Forest plots representing the risk of all-cause mortality after 1- and 3-month abbreviated DAPT vs. conventional DAPT; C Forest plots representing the risk of all-cause mortality after abbreviated DAPT vs. conventional DAPT in pre-specified subgroups; D Forest plots representing the risk of cardiovascular mortality after abbreviated DAPT vs. conventional DAPT

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Fig. 3
figure 3

Ischemic Outcomes: A Forest plots representing the risk of stroke after abbreviated DAPT vs. conventional DAPT; B Forest plots representing the risk of non-fatal MI after abbreviated DAPT vs. conventional DAPT; C Forest plots representing the risk of any revascularization after abbreviated DAPT vs. conventional DAPT; D Forest plots representing the risk of target vessel revascularization after abbreviated DAPT vs. conventional DAPT

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Cardiovascular mortality

Abbreviated DAPT was not significantly associated with a reduced risk of CV mortality compared to conventional DAPT (RR: 0.88, 95%CI: 0.76–1.02, I2: 0%) (Fig. 2D). Subgroup analysis based on DAPT duration showed no statistically significant differences in CV mortality: 1-month DAPT (RR: 0.87, 95%CI: 0.73–1.04, I2: 0%) and 3-month DAPT (RR: 0.91, 95%CI: 0.70–1.18, I2: 0%) (Supplemental Fig. 3). Moreover, the risk of CV mortality was comparable between abbreviated and conventional DAPT in all other subgroup analyses, except for a 49% lower risk observed in women who underwent abbreviated DAPT (RR: 0.51, 95%CI: 0.28–0.92, I2: 0%) (Supplemental Figs. 4, 5).

Fig. 4
figure 4

A Forest plots representing the risk of in-stent thrombosis after abbreviated DAPT vs. conventional DAPT; B Forest plots representing the risk of MACE after abbreviated DAPT vs. conventional DAPT

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Fig. 5
figure 5

Forest plots representing the risk of BARC after abbreviated DAPT vs. conventional DAPT

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Stroke

Based on 11 studies involving 58174 patients, there was no statistically significant difference in stroke rates between abbreviated DAPT and conventional DAPT (RR: 0.93, 95%CI: 0.79–1.10, I2: 0%) (Fig. 3A). Subgroup analysis by DAPT duration also showed no significant difference in stroke rates: 1-month DAPT (RR: 0.89, 95%CI: 0.74–1.07, I2: 0%) and 3-month DAPT (RR: 1.14, 95%CI: 0.78–1.67, I2: 0%) (Supplemental Fig. 6). Furthermore, additional subgroup analyses revealed no significant differences in stroke risk across various pre-specified subgroups (Supplemental Figs. 7, 8).

Fig. 6
figure 6

Bleeding Outcomes: A Forest plots representing the risk of BARC after abbreviated DAPT vs. conventional DAPT in the complex PCI subgroup; B Forest plots representing the risk of BARC after abbreviated DAPT vs. conventional DAPT in the ACS subgroup; C Forest plots representing the risk of BARC after abbreviated DAPT vs. conventional DAPT in the HBR subgroup

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Non-fatal myocardial infarction

The incidence of non-fatal MI was comparable between patients receiving abbreviated DAPT and those receiving conventional regimen (RR: 0.97, 95%CI: 0.85–1.10, I2: 19%) (Fig. 3B). These results remained consistent across different durations of abbreviated DAPT, including 1-month DAPT (RR: 0.95, 95%CI: 0.74–1.23, I2: 62%) and 3-month DAPT (RR: 1.01, 95%CI: 0.84–1.22, I2: 0%) (Supplemental Fig. 9). Subgroup analyses based on pre-specified factors did not reveal any statistically significant difference in non-fatal MI rates between the two groups (Supplemental Figs. 10, 11).

Any revascularization

The rate of any revascularization was reported in six studies. Compared to conventional DAPT, abbreviated DAPT did not significantly reduce the risk of any revascularization (RR: 0.99, 95%CI: 0.89–1.10, I2: 31%) (Figs. 3C). This trend remained consistent in the subgroup analysis of different abbreviated DAPT durations: 1-month DAPT (RR: 0.95, 95%CI: 0.88–1.04, I2: 60%) and 3-month DAPT (RR: 1.06, 95%CI: 0.83–1.36, I2: 0%) (Supplemental Fig. 12). Additionally, the risk of any revascularization was similar between abbreviated and conventional DAPT across subgroups defined by DM, ACS, HBR, and complex PCI (Supplemental Figs. 13, 14), with subgroup analysis showing no significant difference in pooled risk (P: 0.83).

Target vessel revascularization

No statistically significant difference was found between abbreviated and conventional DAPT regarding the occurrence of target vessel revascularization (RR: 0.94, 95%CI: 0.82–1.07, I2: 12%) (Fig. 3D). Similarly, no difference was found in the risk of target vessel revascularization across different durations of abbreviated DAPT: 1-month DAPT (RR: 0.87, 95%CI:0.73–1.04, I2: 39%) and 3-month DAPT (RR: 1.07, 95%CI: 0.88–1.30, I2: 0%) (Supplemental Fig. 15). Subgroup analyses based on gender, BMI, elderly, HBR, and comorbidities such as ACS and DM revealed no significant difference in target vessel revascularization (Supplemental Figs. 16, 17).

In-stent thrombosis

The incidence of in-stent thrombosis was assessed in 13 studies, revealing no significant difference between abbreviated DAPT versus conventional DAPT (RR: 1.04, 95%CI: 0.87–1.23, I2: 0%) (Fig. 4A). The risk of in-stent thrombosis with 1- or 3-month abbreviated DAPT regimens was comparable to conventional DAPT (RR: 0.97, 95%CI: 0.75–1.26, I2: 0%; RR: 1.12, 95%CI: 0.87–1.44, I2: 0%, respectively) (Supplemental Fig. 18). Subgroup analysis based on different characteristics and various comorbidities, yielded similar outcomes to the overall analysis (Supplemental Figs. 19, 20).

MACE

No significant difference was found in the incidence of MACEs between patients receiving abbreviated DAPT and those receiving conventional DAPT (RR: 0.93, 95%CI: 0.83–1.04, I2: 0%) (Figs. 4B). The risk of MACEs remained comparable across different durations of abbreviated DAPT, including 1-month (RR: 0.90, 95%CI: 0.77–1.05, I2: 0%) and 3-month DAPT (RR: 0.96, 95%CI: 0.82–1.12, I2: 0%) (Supplemental Fig. 21), with subgroup analysis showing no significant difference in pooled risk (P: 0. 56). Notably, abbreviated DAPT was associated with significantly lower risk of MACEs compared to conventional DAPT among patients undergoing complex PCI (RR: 0.84, 95%CI: 0.75–0.94, I2: 0%); However, no difference was observed between the two regimens across other pre-specified subgroups (Supplemental Figs. 22, 23).

BARC

The incidence of BARC type 2 or 3 or 5 bleeding was reduced by 30% with abbreviated DAPT compared to conventional DAPT (RR: 0.70, 95%CI: 0.50–0.98, I2: 88%). However, there was high heterogeneity among the seven studies reporting this outcome. Abbreviated DAPT also significantly lowered the risk of BARC 3 or 5 bleeding (RR: 0.77, 95%CI: 0.60–0.97, I2: 67%). However, there was no significant difference in the rate of BARC type 2 (RR: 0.83, 95%CI: 0.68–1.01, I2: 63%), BARC type 3 (RR: 0.98, 95%CI: 0.86–1.11, I2: 0%), and BARC type 5 bleeding (RR: 1.01, 95%CI: 0.70–1.44, I2: 20%) between abbreviated DAPT and conventional DAPT (Figs. 5).

A pre-specified analysis of bleeding endpoints was conducted based on the presence of ACS, PCI complexity, and HBR status. Among patients undergoing complex PCI, abbreviated DAPT resulted in lower rates of BARC 2 or 3 or 5 bleeding (RR: 0.56, 95%CI: 0.40–0.77, I2: 0%), while the risk of BARC type 3, BARC type 5, and BARC 3 or 5 bleeding did not significantly differ in this population (Fig. 6A). In the ACS subgroup, abbreviated DAPT was associated with lower rates of BARC type 3 (RR: 0.55, 95%CI: 0.32–0.96, I2: 55%) and BARC 3 or 5 bleeding (RR: 0.60, 95%CI: 0.39–0.94, I2: 76%), with no significant differences in BARC type 5 bleeding (RR: 1.13, 95%CI: 0.54–2.36, I2: 0%) (Figs. 6B). In the HBR subgroup analysis, there was a substantial reduction in the incidence of BARC 3 or 5 bleeding in HBR patients randomized to abbreviated DAPT compared with those randomized to conventional DAPT (RR: 0.40, 95%CI: 0.18–0.90, I2: 82%). However, significant heterogeneity was observed among studies reporting this outcome in HBR patients. Furthermore, there were no significant differences between abbreviated DAPT and conventional DAPT in terms of BARC type 5 and BARC type 2 or 3 or 5 bleeding (RR: 0.76, 95%CI: 0.32–1.81, I2: 0%; RR: 0.69, 95%CI: 0.47–1.01, I2: 62%, respectively) (Figs. 6C).

Sensitivity analysis

Supplemental Table 2 shows the sensitivity analysis using the leave-one-out analysis, which showed that removing none of the studies shows a significant difference in overall analysis. Meta-regression based on mean age, male percentage, DM, and hypertension was performed, as shown in Supplementary Figs. 24–27. As indicated, none of the variables had an association with all-cause mortality.

Publication bias

No significant publication bias was identified upon reviewing Begg’s funnel plots and conducting Egger’s test for all outcomes. The corresponding funnel plots are illustrated in Supplemental Figs. 28–33.

Discussion

This meta-analysis of RCTs evaluating abbreviated vs. conventional DAPT strategies following PCI revealed a favorable trend for shorter DAPT durations. While ischemic outcomes, including target vessel revascularization, any vessel revascularization, stroke, myocardial infarction, and in-stent restenosis, were comparable between the two strategies, abbreviated DAPT demonstrated significant advantages in terms of mortality and bleeding.

In terms of mortality, the study revealed a critical finding regarding all-cause mortality, which was significantly lower in the abbreviated DAPT group. It is noteworthy that in previous meta-analysis studies, all-cause mortality was not significantly different between conventional and abbreviated DAPT strategies [60, 61], our study provides a thought provoking benefit of the abbreviated DAPT strategy. This benefit was also observed in patients receiving DAPT for only one month, suggesting a potential opportunity worthwhile further investigation.

Current guidelines recommend DAPT duration for 6–12 months after PCI for the treatment of chronic coronary syndrome (CCS) and ACS [62,63,64]. However, in congruence with several meta-analyses in different populations after PCI, the similarity in ischemic outcomes across all subgroup analyses suggests that abbreviated DAPT does not compromise efficacy in preventing ischemic events [65,66,67,68,69].

To address the balance between bleeding and thrombosis, this meta-analysis further supports abbreviated DAPT, specifically showing fewer bleeding issues without compromising thrombosis.

Overt and severe bleeding (BARC 2, 3, 5) and severe bleeding (BARC 3, 5) were significantly reduced in the abbreviated DAPT group. These findings suggest that an abbreviated DAPT strategy may be associated with lower rates of bleeding events, particularly in certain subgroups of patients, which is in line with previous studies [65, 68]. Importantly, this benefit extended to patients at high bleeding risk, patients with complicated PCI, and those with acute coronary syndromes, demonstrating the safety and effectiveness of this strategy.

A prominent strength of our article lies in its comprehensive assessment of outcomes across the cardiometabolic disease spectrum. The effect on outcomes was consistent across subgroup analysis, with the most intriguing findings below:

While previous guidelines recommend prolonged DAPT (3–6 months) for HBR patients [1, 62], this meta-analysis and several others [70,71,72] support abbreviated DAPT (1–3 months) as a safer alternative, reducing bleeding events without compromising ischemic protection. Additionally, the State-of-the-Art Review by Galli et al. suggested an individualized approach for DAPT strategy favoring the abbreviated DAPT approach [73].

Furthermore, optimal duration of DAPT in patients undergoing complex PCI remains under investigation, Apostolos et al. demonstrated that abbreviated DAPT significantly reduced the odds of major bleeding in patients undergoing complex PCI without increasing the ischemic events or mortality. Thus, it could be considered a safe and feasible option for such patients [69]. Moreover, it found that abbreviated DAPT was associated with lower MACE rates in this group, demonstrating its effectiveness in more complex scenarios [74, 75].

While concerns remain about increased ischemic events with abbreviated DAPT in ACS patients, Park et al. [76] suggest that abbreviated DAPT (1–3 months) offers similar ischemic protection with reduced bleeding risk compared to conventional DAPT (6–12 months). However, the most recent ACC guideline recommended that in ACS patients who are not at high bleeding risk, DAPT should be continued at least 1 year to reduce MACE. It is noteworthy that the 2025 ACC guideline also recommended an abbreviated DAPT strategy (after 1 month) as a logical approach in ACS patients with high bleeding risk with class of recommendation 2b [77].

This study observed a significant reduction in CV mortality among women receiving abbreviated DAPT. Given that several studies have introduced the female sex as a poor prognostic factor after PCI, probably due to older age and comorbidities [78,79,80] and different platelet reactivity and response to antiplatelet therapy in women compared to men [81], this gender-specific difference warrants further investigation, potentially concerning inherent dissimilarity in bleeding risk or DAPT response between men and women.

Furthermore, our analysis of secondary stenotic outcomes revealed minimal heterogeneity (I2: 0–12%) regarding Cardiovascular mortality, stroke, in-stent thrombosis, and MACE across total and subgroup analysis, indicating highly consistent findings across included studies. However, non-fatal myocardial infarction showed low heterogeneity overall (I2: 19%), with the 1-month DAPT subgroup demonstrating moderate heterogeneity (I2: 62%). Additionally, any revascularization displayed moderate heterogeneity overall (I2: 31%) with the 1-month DAPT subgroup demonstrating more heterogeneity (I2: 60%). The aforementioned heterogeneity may reflect differences in study design or patient characteristics. However, sensitivity analyses confirmed that this variation does not materially affect the overall conclusion that abbreviated DAPT provides comparable protection against stenotic outcomes.

Our meta-analysis had some limitations, first, this is a study-level meta-analysis; thus, it was not feasible to perform a patient-level analysis. The different durations of follow-up and different P2Y12 inhibitors used across included RCTs may have affected the final results. Additionally, another possible limitation of our study may be attributable to the heterogeneity among patient populations and follow-up periods, differences in age mix, concomitant disorders, and gender ratio, which may affect the generalizability of our results. However, extensive sensitivity analyses and subgroup analysis were conducted to provide robustness of the results. Another limitation is that hazard ratios were not reported for all outcomes in the examined studies, preventing us from using HR as a consistent effect estimate to combine long-term statistics across studies. Furthermore, the term “complex PCI” encompasses a spectrum of PCI settings, making conducting sub-analyses for each definition impractical. Looking ahead, future studies should focus on overcoming these limitations. Specifically, the inconsistency in reporting HR should be addressed, as using HR would facilitate more robust comparisons across studies, particularly for long-term outcomes. Furthermore, conducting a network meta-analysis could provide more comprehensive insights by allowing the comparison of different treatment regimens, such as the duration of DAPT, even when these have not been directly compared in individual trials. This approach could yield more robust and generalized results, helping to clarify the optimal treatment strategies across varied patient populations and PCI settings.

Conclusion

In conclusion, an abbreviated DAPT strategy appears safe for patients undergoing PCI with less bleeding risks without compromising ischemic outcomes. In specific subgroups like females and complex PCI patients, individual patient characteristics and risk profiles should continue to guide clinical decision-making. The current evidence supports a move towards personalized antiplatelet therapy, where the duration of DAPT is tailored to each patient.

Data availability

Data is provided within the manuscript or supplementary information files.

References

  1. Valgimigli M, Bueno H, Byrne RA, Collet J-P, Costa F, Jeppsson A, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018;39(3):213–60.

    Article  PubMed  Google Scholar 

  2. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(2):e21–129.

    Article  PubMed  Google Scholar 

  3. Carciotto G, Costa F, Garcia-Ruiz V, Galli M, Soraci E, Magliarditi A, et al. Individualization of Duration of Dual Antiplatelet Therapy after Coronary Stenting: A Comprehensive, Evidence-Based Review. J Clin Med. 2023;12(22):7144.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Khan SU, Kleiman NS. Optimizing Dual Antiplatelet Therapy After Percutaneous Coronary Intervention in Older Adults. JAMA Network Open. 2024;7(3):e246951-e.

    Article  PubMed  Google Scholar 

  5. Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045–57.

    Article  CAS  PubMed  Google Scholar 

  6. Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357(20):2001–15.

    Article  CAS  PubMed  Google Scholar 

  7. Franzone A, McFadden EP, Leonardi S, Piccolo R, Vranckx P, Serruys PW, et al. Ticagrelor alone or conventional dual antiplatelet therapy in patients with stable or acute coronary syndromes. EuroIntervention. 2020;16(8):627–33.

    Article  PubMed  Google Scholar 

  8. Hahn JY, Song YB, Oh JH, Chun WJ, Park YH, Jang WJ, et al. Effect of P2Y12 Inhibitor Monotherapy vs Dual Antiplatelet Therapy on Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention: The SMART-CHOICE Randomized Clinical Trial. JAMA. 2019;321(24):2428–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Kim CJ, Park MW, Kim MC, Choo EH, Hwang BH, Lee KY, et al. Unguided de-escalation from ticagrelor to clopidogrel in stabilised patients with acute myocardial infarction undergoing percutaneous coronary intervention (TALOS-AMI): an investigator-initiated, open-label, multicentre, non-inferiority, randomised trial. Lancet. 2021;398(10308):1305–16.

    Article  CAS  PubMed  Google Scholar 

  10. Watanabe H, Morimoto T, Natsuaki M, Yamamoto K, Obayashi Y, Ogita M, et al. Comparison of Clopidogrel Monotherapy After 1 to 2 Months of Dual Antiplatelet Therapy With 12 Months of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome: The STOPDAPT-2 ACS Randomized Clinical Trial. JAMA Cardiol. 2022;7(4):407–17.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Han JK, Hwang D, Yang S, Park SH, Kang J, Yang HM, et al. Comparison of 3- to 6-Month Versus 12-Month Dual Antiplatelet Therapy After Coronary Intervention Using the Contemporary Drug-Eluting Stents With Ultrathin Struts: The HOST-IDEA Randomized Clinical Trial. Circulation. 2023;147(18):1358–68.

    Article  CAS  PubMed  Google Scholar 

  12. Natsuaki M, Watanabe H, Morimoto T, Yamamoto K, Obayashi Y, Nishikawa R, et al. An aspirin-free versus dual antiplatelet strategy for coronary stenting: STOPDAPT-3 randomized trial. Circulation. 2024;149(8):585–600.

    Article  CAS  PubMed  Google Scholar 

  13. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, The PRISMA, et al. statement: an updated guideline for reporting systematic reviews. BMJ. 2020;2021:372.

    Google Scholar 

  14. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5:1–10.

    Article  Google Scholar 

  15. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123(23):2736–47.

    Article  PubMed  Google Scholar 

  16. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JA. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343.

  17. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.

    Article  PubMed  Google Scholar 

  18. Cochran WG. Some methods for strengthening the common χ 2 tests. Biometrics. 1954;10(4):417–51.

    Article  Google Scholar 

  19. Sterne JA, Egger M, Smith GD. Investigating and dealing with publication and other biases in meta-analysis. BMJ. 2001;323(7304):101–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Team RD. R: A language and environment for statistical computing. (No Title). 2010.

  21. Balduzzi S, Rücker G, Schwarzer G. How to perform a meta-analysis with R: a practical tutorial. BMJ Ment Health. 2019;22(4):153–60.

    Google Scholar 

  22. McGuinness LA. robvis: An R package and web application for visualising risk-of-bias assessments. 2019. Github URL: https://github.com/mcguinlu/robvis. Accessed 2021–07–31.

  23. Kim BK, Hong MK, Shin DH, Nam CM, Kim JS, Ko YG, et al. A new strategy for discontinuation of dual antiplatelet therapy: the RESET Trial (REal Safety and Efficacy of 3-month dual antiplatelet Therapy following Endeavor zotarolimus-eluting stent implantation). J Am Coll Cardiol. 2012;60(15):1340–8.

    Article  CAS  PubMed  Google Scholar 

  24. Feres F, Costa RA, Abizaid A, Leon MB, Marin-Neto JA, Botelho RV, et al. Three vs twelve months of dual antiplatelet therapy after zotarolimus-eluting stents: the OPTIMIZE randomized trial. JAMA. 2013;310(23):2510–22.

    CAS  PubMed  Google Scholar 

  25. Kim B-K, Hong S-J, Cho Y-H, Yun KH, Kim YH, Suh Y, et al. Effect of ticagrelor monotherapy vs ticagrelor with aspirin on major bleeding and cardiovascular events in patients with acute coronary syndrome: the TICO randomized clinical trial. JAMA. 2020;323(23):2407–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Kedhi E, Verdoia M, Suryapranata H, Damen S, Camaro C, Benit E, et al. Impact of age on the comparison between short-term vs 12-month dual antiplatelet therapy in patients with acute coronary syndrome treated with the COMBO dual therapy stent: 2-Year follow-up results of the REDUCE trial. Atherosclerosis. 2021;321:39–44.

    Article  CAS  PubMed  Google Scholar 

  27. Choi KH, Park YH, Song YB, Park TK, Lee JM, Yang JH, et al. Long-term effects of P2Y12 inhibitor monotherapy after percutaneous coronary intervention: 3-year follow-up of the SMART-CHOICE randomized clinical trial. JAMA Cardiology. 2022;7(11):1100–8.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Vranckx P, Valgimigli M, Jüni P, Hamm C, Steg PG, Heg D, et al. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial. The Lancet. 2018;392(10151):940–9.

    Article  CAS  Google Scholar 

  29. Landi A, Heg D, Frigoli E, Vranckx P, Windecker S, Siegrist P, et al. Abbreviated or standard antiplatelet therapy in HBR patients: final 15-month results of the MASTER-DAPT trial. Cardiovascular Interventions. 2023;16(7):798–812.

    Article  PubMed  Google Scholar 

  30. Hong S-J, Lee S-J, Suh Y, Yun KH, Kang TS, Shin S, et al. Stopping aspirin within 1 month after stenting for ticagrelor monotherapy in acute coronary syndrome: the T-PASS randomized noninferiority trial. Circulation. 2024;149(8):562–73.

    Article  PubMed  Google Scholar 

  31. Watanabe H, Morimoto T, Natsuaki M, Yamamoto K, Obayashi Y, Nishikawa R, et al. Clopidogrel vs aspirin monotherapy beyond 1 year after percutaneous coronary intervention. J Am Coll Cardiol. 2024;83(1):17–31.

    Article  CAS  PubMed  Google Scholar 

  32. Mehran R, Baber U, Sharma SK, Cohen DJ, Angiolillo DJ, Briguori C, et al. Ticagrelor with or without aspirin in high-risk patients after PCI. N Engl J Med. 2019;381(21):2032–42.

    Article  CAS  PubMed  Google Scholar 

  33. Franzone A, et al. “Ticagrelor Alone Versus Dual Antiplatelet Therapy From 1 Month After Drug-Eluting Coronary Stenting,” (in eng). J Am Coll Cardiol. 2019;74(18):2223–34. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jacc.2019.08.1038.

    Article  CAS  PubMed  Google Scholar 

  34. Serruys PW, et al. Impact of long-term ticagrelor monotherapy following 1-month dual antiplatelet therapy in patients who underwent complex percutaneous coronary intervention: insights from the Global Leaders trial. Eur Heart J. 2019;40(31):2595–604.

    Article  CAS  PubMed  Google Scholar 

  35. Ono M, et al. “The association of body mass index with long-term clinical outcomes after ticagrelor monotherapy following abbreviated dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a prespecified sub-analysis of the GLOBAL LEADERS Trial,” (in eng). Clin Res Cardiol. 2020;109(9):1125–39. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00392-020-01604-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36.  Gao C, et al. Ticagrelor monotherapy in patients with concomitant diabetes mellitus and chronic kidney disease: a post hoc analysis of the GLOBAL LEADERS trial. Cardiovasc Diabetol. 2020;19(1):179. 2020/10/16 2020, https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12933-020-01153-x.

  37. Vranckx P, et al. Efficacy and safety of ticagrelor monotherapy by clinical presentation: pre-specified analysis of the GLOBAL LEADERS Trial. J Am Heart Assoc. 2021;10(18):e015560.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Baber U, et al. Ticagrelor alone vs. ticagrelor plus aspirin following percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndromes: TWILIGHT-ACS. Eur Heart J. 2020;41(37):3533–45.

    Article  CAS  PubMed  Google Scholar 

  39. Dangas G, et al. Ticagrelor with or without aspirin after complex PCI. J Am Coll Cardiol. 2020;75(19):2414–24.

    Article  CAS  PubMed  Google Scholar 

  40. Vogel B, et al. Sex differences among patients with high risk receiving ticagrelor with or without aspirin after percutaneous coronary intervention: a subgroup analysis of the TWILIGHT randomized clinical trial. JAMA cardiology. 2021;6(9):1032–41.

    Article  PubMed  Google Scholar 

  41. Stefanini GG, et al. Ticagrelor monotherapy in patients with chronic kidney disease undergoing percutaneous coronary intervention: TWILIGHT-CKD. Eur Heart J. 2021;42(45):4683–93.

    Article  CAS  PubMed  Google Scholar 

  42. Escaned J, et al. Ticagrelor monotherapy in patients at high bleeding risk undergoing percutaneous coronary intervention: TWILIGHT-HBR. Eur Heart J. 2021;42(45):4624–34.

    Article  CAS  PubMed  Google Scholar 

  43. Kunadian V, et al. Bleeding and ischemic outcomes with ticagrelor monotherapy according to body mass index. Cardiovascular Interventions. 2022;15(19):1948–60.

    Article  PubMed  Google Scholar 

  44. Dehghani P, et al. Ticagrelor monotherapy after PCI in patients with concomitant diabetes mellitus and chronic kidney disease: TWILIGHT DM-CKD. Eur Heart J Cardiovasc Pharmacother. 2022;8(7):707–16.

    Article  PubMed  Google Scholar 

  45. Yun KH, et al. Ischemic and bleeding events of ticagrelor monotherapy in Korean patients with and without diabetes mellitus: insights from the TICO trial. Front Pharmacol. 2021;11:620906.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Kim BG, et al. Age-Dependent Effect of Ticagrelor Monotherapy Versus Ticagrelor With Aspirin on Major Bleeding and Cardiovascular Events: A Post Hoc Analysis of the TICO Randomized Trial. J Am Heart Assoc. 2021;10(24):e022700.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Lee SJ, et al. Ticagrelor monotherapy versus ticagrelor with aspirin in acute coronary syndrome patients with a high risk of ischemic events. Circ Cardiovasc Intervent. 2021;14(8):010812.

    Article  Google Scholar 

  48. Lee Y-J, et al. Ticagrelor monotherapy after 3-month dual antiplatelet therapy in acute coronary syndrome by high bleeding risk: the subanalysis from the TICO trial. Korean Circ J. 2022;52(4):324.

    Article  PubMed  Google Scholar 

  49. Lee B, et al. Sex differences in outcomes of ticagrelor therapy with or without aspirin after percutaneous coronary intervention in patients with acute coronary syndrome: A post hoc secondary analysis of the TICO randomized clinical trial. Arterioscler Thromb Vasc Biol. 2023;43(6):e218–26.

    Article  CAS  PubMed  Google Scholar 

  50. Kim BG, et al. Body mass index affecting ticagrelor monotherapy vs. ticagrelor with aspirin in patients with acute coronary syndrome: A pre-specified sub-analysis of the TICO randomized trial. Front Cardiovasc Med. 2023;10:1128834.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Verdoia M, et al. “Gender differences with short-term vs 12 months dual antiplatelet therapy in patients with acute coronary syndrome treated with the COMBO dual therapy stent: 2-years follow-up results of the REDUCE trial,” (in eng). J Thromb Thrombolysis. 2021;52(3):797–807. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s11239-021-02439-x.

    Article  CAS  PubMed  Google Scholar 

  52. Vranken NPA, et al. “Short-term dual antiplatelet therapy in diabetic patients admitted for acute coronary syndrome treated with a new-generation drug-eluting stent,” (in eng). Diabetes Metab Res Rev. 2022;38(5):e3530. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/dmrr.3530.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Roh JW, et al. P2Y12 inhibitor monotherapy in complex percutaneous coronary intervention: a post-hoc analysis of SMART-CHOICE randomized clinical trial. Cardiol J. 2021;28(6):855–63.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Shin ES, Her AY, Kim B, Hahn JY, Song YB, Lee JM, Park TK, Yang JH, Choi JH, Choi SH, Lee SH. Sex-based outcomes of P2Y12 inhibitor monotherapy after three months of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention. J Korean Med Sci. 2023;38(45).

  55. Valgimigli M, et al. Duration of antiplatelet therapy after complex percutaneous coronary intervention in patients at high bleeding risk: a MASTER DAPT trial sub-analysis. Eur Heart J. 2022;43(33):3100–14.

    Article  PubMed  Google Scholar 

  56. Landi A, et al. Abbreviated or Standard Dual Antiplatelet Therapy by Sex in Patients at High Bleeding Risk: A Prespecified Secondary Analysis of a Randomized Clinical Trial. JAMA cardiology. 2024;9(1):35–44.

    Article  PubMed  Google Scholar 

  57. Yamamoto K, et al. Clopidogrel monotherapy after 1-month DAPT in patients with high bleeding risk or complex PCI. JACC: Asia. 2023;3(1):31–46.

  58. Yamamoto K, et al. Clopidogrel monotherapy after 1-month dual antiplatelet therapy in patients with diabetes undergoing percutaneous coronary intervention. Cardiovasc Intervent. 2023;16(1):19–31.

    Article  Google Scholar 

  59. Obayashi Y, Natsuaki M, Watanabe H, Morimoto T, Yamamoto K, Nishikawa R, Ando K, Suwa S, Isawa T, Takenaka H, Ishikawa T. Aspirin-free strategy for percutaneous coronary intervention in acute coronary syndrome based on the subtypes of acute coronary syndrome and high bleeding risk: the STOPDAPT-3 trial. Eur Heart J Cardiovasc Pharmacother. 2024;10(5):374–90.

    Article  PubMed  Google Scholar 

  60. Tsigkas G, Apostolos A, Trigka A, Chlorogiannis D, Katsanos K, Toutouzas K, et al. Very Short Versus Longer Dual Antiplatelet Treatment After Coronary Interventions: A Systematic Review and Meta-analysis. Am J Cardiovasc Drugs. 2023;23(1):35–46.

    Article  CAS  PubMed  Google Scholar 

  61. Wernly B, Rezar R, Gurbel P, Jung C. Short-term dual antiplatelet therapy (DAPT) followed by P2Y12 monotherapy versus traditional DAPT in patients undergoing percutaneous coronary intervention: meta-analysis and viewpoint. J Thromb Thrombolysis. 2020;49(1):173–6.

    Article  CAS  PubMed  Google Scholar 

  62. Collet J-P, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2021;42(14):1289–367.

    Article  PubMed  Google Scholar 

  63. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2020;41(3):407–77.

    Article  PubMed  Google Scholar 

  64. Members WC, Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(2):e21–129.

    Article  Google Scholar 

  65. Costa F, Montalto C, Branca M, Hong S-J, Watanabe H, Franzone A, et al. Dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk: a meta-analysis of randomized trials. Eur Heart J. 2022;44(11):954–68.

    Article  Google Scholar 

  66. Park DY, An S, Kumar A, Malhotra S, Jolly N, Kaur A, et al. Abbreviated versus Standard Duration of DAPT after PCI: A Systematic Review and Network Meta-analysis. Am J Cardiovasc Drugs. 2022;22(6):633–45.

    Article  PubMed  Google Scholar 

  67. Kuno T, Watanabe A, Shoji S, Fujisaki T, Ueyama H, Takagi H, et al. Short-Term DAPT and DAPT De-Escalation Strategies for Patients With Acute Coronary Syndromes: A Systematic Review and Network Meta-Analysis. Circulation: Cardiovascular Interventions. 2023;16(9):e013242.

  68. Park DY, Hu J-R, Jamil Y, Kelsey MD, Jones WS, Frampton J, et al. Shorter Dual Antiplatelet Therapy for Older Adults After Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis. JAMA Network Open. 2024;7(3):e244000-e.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Apostolos A, Chlorogiannis D, Vasilagkos G, Katsanos K, Toutouzas K, Aminian A, et al. Safety and efficacy of shortened dual antiplatelet therapy after complex percutaneous coronary intervention: A systematic review and meta-analysis. Hellenic J Cardiol. 2023;71:33–41.

    Article  PubMed  Google Scholar 

  70. Bainey KR, Marquis-Gravel G, MacDonald BJ, Bewick D, Yan A, Turgeon RD. Short dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk patients: Systematic review and meta-analysis. PLoS ONE. 2023;18(9):e0291061.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Zhang J, Chen Z, Li C, Wang D, He S, Luo C, et al. Short dual antiplatelet therapy in patients with high bleeding risk undergoing percutaneous coronary intervention: a systematic review and meta-analysis. Coron Artery Dis. 2022;33(7):580–9.

    Article  PubMed  Google Scholar 

  72. Garg A, Rout A, Farhan S, Waxman S, Giustino G, Tayal R, et al. Dual antiplatelet therapy duration after percutaneous coronary intervention using drug eluting stents in high bleeding risk patients: A systematic review and meta-analysis. Am Heart J. 2022;250:1–10.

    Article  CAS  PubMed  Google Scholar 

  73. Galli M, Gragnano F, Berteotti M, Marcucci R, Gargiulo G, Calabrò P, et al. Antithrombotic Therapy in High Bleeding Risk, Part I: Percutaneous Cardiac Interventions. JACC: Cardiovascular Interventions. 2024;17(19):2197–215.

  74. Costa F, Van Klaveren D, Feres F, James S, Räber L, Pilgrim T, et al. Dual Antiplatelet Therapy Duration Based on Ischemic and Bleeding Risks After Coronary Stenting. J Am Coll Cardiol. 2019;73(7):741–54.

    Article  PubMed  Google Scholar 

  75. Yeh RW, Kereiakes DJ, Steg PG, Cutlip DE, Croce KJ, Massaro JM, et al. Lesion Complexity and Outcomes of Extended Dual Antiplatelet Therapy After Percutaneous Coronary Intervention. J Am Coll Cardiol. 2017;70(18):2213–23.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Park DY, Wang P, An S, Grimshaw AA, Frampton J, Ohman EM, et al. Shortening the duration of dual antiplatelet therapy after percutaneous coronary intervention for acute coronary syndrome: A systematic review and meta-analysis. Am Heart J. 2022;251:101–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. Rao SV, O’Donoghue ML, Ruel M, Rab T, Tamis-Holland JE, Alexander JH, Baber U, Baker H, Cohen MG, Cruz-Ruiz M, Davis LL. 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025;151(13):e771-862.

    PubMed  Google Scholar 

  78. Guo Y, Yin F, Fan C, Wang Z. Gender difference in clinical outcomes of the patients with coronary artery disease after percutaneous coronary intervention: A systematic review and meta-analysis. Medicine. 2018;97(30):e11644.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Kosmidou I, Leon MB, Zhang Y, Serruys PW, Birgelen CV, Smits PC, et al. Long-Term Outcomes in Women and Men Following Percutaneous Coronary Intervention. Journal of the American College of Cardiology. 2020;75(14):1631–40.

    Article  PubMed  Google Scholar 

  80. Lempereur M, Magne J, Cornelis K, Hanet C, Taeymans Y, Vrolix M, et al. Impact of gender difference in hospital outcomes following percutaneous coronary intervention. Results of the Belgian Working Group on Interventional Cardiology (BWGIC) registry. EuroIntervention. 2016;12(2):e216–23.

    Article  PubMed  Google Scholar 

  81. Gasecka A, Zimodro JM, Appelman Y. Sex differences in antiplatelet therapy: state-of-the art. Platelets. 2023;34(1):2176173.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran

    Hamidreza Soleimani, Elaheh Karimi, Mehrdad Mahalleh, Fatemeh Jodeiri Entezari, Ali Nasrollahizadeh, Amir Nasrollahizadeh, Hamed Rafiee, Parvin Kalhor & Kaveh Hosseini

  2. Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Mehrdad Mahalleh

  3. Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

    Ali Nasrollahizadeh

  4. Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, TX, USA

    Karim M. Al-Azizi

  5. Division of Cardiology, Rooney Heart Institute, Naples, FL, USA

    Luis H. Paz Rios

  6. Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, 10595, USA

    Wilbert S. Aronow

  7. Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA

    Andrew P. Ambrosy

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H.R.S.: Supervision, data analysis and visualization, and drafting of the manuscript. E.K.: Title/abstract screening, full-text screening, data extraction, and drafting of the manuscript. M.M.: Title/abstract screening, full-text screening, and data extraction. F.J.E.: Title/abstract screening, full-text screening, and data extraction. A1.N.: Visualization and drafting of the manuscript. A2.N.: Visualization and drafting of the manuscript. H.R.: Title/abstract screening and full-text screening. P.K.: Supervision. K.M.A.: Supervision and review of the final manuscript. L.H.P.R.: Supervision and review of the final manuscript. W.S.A.: Supervision and review of the final manuscript. A.P.A.: Supervision and review of the final manuscript. K.H.: Conceptualization of the work, supervision and final approval of the manuscript.

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Soleimani, H., Karimi, E., Mahalleh, M. et al. Abbreviated dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 25, 343 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12872-025-04765-x

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BMC Cardiovascular Disorders

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