Very Short Versus Longer Dual Antiplatelet Treatment After Coronary Interventions: A Systematic Review and Meta-analysis

Grigorios Tsigkas, Anastasios Apostolos, Aikaterini Trigka, Dimitrios Chlorogiannis, Konstantinos Katsanos, Konstantinos Toutouzas, Dimitrios Alexopoulos, Emmanouil S. Brilakis, Periklis Davlouros

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


Background: Very short (≤ 3 months) duration of dual antiplatelet therapy (VSDAPT) has recently been proposed after percutaneous coronary intervention (PCI) with drug-eluting stent (DES). Objectives: The aim of this systematic review and meta-analysis was to compare very short versus > 3 months’ duration of dual antiplatelet treatment (DAPT) in patients undergoing PCI with DES, focusing on ischemic and bleeding events. Methods: Three major databases (Medline, Cochrane Central Register of Controlled Trials, and Scopus) were screened for eligible randomized controlled trials (RCTs). The primary endpoint of our meta-analysis was the incidence of net adverse clinical events (NACE), as defined per trial, while secondary endpoints were major adverse cardiovascular events (MACE), all-cause and cardiovascular mortality, myocardial infarction, stroke, stent thrombosis, repeat revascularization, and major bleeding. Results: We included eight RCTs with a total of 41,204 patients; 20,592 patients were allocated to VSDAPT and the remaining 20,612 patients were randomized to a longer DAPT period. The abbreviated regimen significantly reduced NACE (odds ratio [OR] 0.83, 95% confidence interval [Cl] 0.74–0.95) and major bleeding (OR 0.71, 95% Cl 0.61–0.82), without affecting mortality or ischemic events (stroke, myocardial infarction, revascularization, and stent thrombosis). Conclusions: VSDAPT significantly decreased the odds of NACEs and major bleeding by 17% and 29%, respectively, without increasing ischemic events. Thus, VSDAPT could be well tolerated and feasible after PCI with DES. Clinical Trials Registration: Open Science Framework (10.17605/OSF.IO/4H2JB) Graphical Abstract: Very short-term DAPT significantly reduces NACE and major bleedings, without affecting mortality and ischemic events (MACE, MI, stroke, stent thrombosis and revascularization). CI confidence intervals, DAPT dual antiplatelet therapy, DES drug-eluting stents, MACE major adverse cardiovascular events, MI myocardial infarction, NACE net adverse clinical events, OR odds ratio, PCI percutaneous coronary interventions.[Figure not available: see fulltext.]

Original languageEnglish (US)
Pages (from-to)35-46
Number of pages12
JournalAmerican Journal of Cardiovascular Drugs
Issue number1
StatePublished - Jan 2023
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)


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