| Abstract: |
Background: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor antagonist is the standard antithrombotic therapy after percutaneous coronary intervention (PCI); however, the optimal duration of this treatment remains a topic of ongoing debate. This study aimed to assess the clinical utility of an ultrashort dual antiplatelet therapy (US-DAPT) regimen (≤1 month) compared with standard DAPT (≥6 months) after PCI. In addition, the outcomes of choosing single antiplatelet therapy after US-DAPT, either clopidogrel or ticagrelor, were also analyzed. Methods: We queried MEDLINE, Cochrane Central Registry of Controlled Trials, Embase, and ClinicalTrials.gov databases from their commencement to May 2024 for all randomized controlled trials (RCTs) that directly compared US-DAPT (≤1 month) with standard therapy (≥6 months). The primary end point was net adverse clinical events (NACE), defined as a composite of major adverse cardiovascular or cerebrovascular events (MACCE) and clinically relevant bleeding (CRB). Results: Seven RCTs were included in the analysis, comprising 34,774 patients (US-DAPT, n = 17,383; standard therapy, n = 17,391) who were enrolled with a mean age of 67 ± 10 years and 74.7% male. US-DAPT was associated with a 20% lower risk of NACE (OR, 0.80; 95% CI, 0.68-0.94; P = .006; I2 = 74%) and 47% reduction in CRB (OR, 0.53; 95% CI, 0.37-0.75; P < .001; I2 = 77%) compared with standard therapy at 12 months. Similarly, US-DAPT was associated with statistically significant reduction in all-cause mortality (OR, 0.88; 95% CI, 0.77-0.99; P = .04; I2 = 0%) and TVR (OR, 0.87; 95% CI, 0.78-0.98; P = .02; I2 = 41%) However, no significant difference in MACCE, all-cause mortality, cardiovascular disease–related deaths, MI, stroke, MI, TVR, and ST was observed. Conclusions: In patients undergoing PCI, US-DAPT was associated with lower NACEs and bleeding risk without increasing the occurrence of ischemic events, including ST and MI, when compared with at least 6 months of DAPT, irrespective of the choice of single antiplatelet therapy, whether clopidogrel or ticagrelor, following DAPT. © 2024 The Author(s) |
