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TOPLINE:

A 1-month regimen of dual antiplatelet therapy (DAPT) after coronary stent implantation was associated with the lowest risk for net adverse clinical events (NACE). Although longer treatment was linked to a lower risk for myocardial infarction (MI), the trade-off between bleeding and MI favored short-term treatment.

METHODOLOGY:

• Researchers compared shorter DAPT regimens with the standard 6- and 12-month regimens in patients with ischemic heart disease to determine the optimal duration of DAPT.
• They conducted a network meta-analysis of 31 randomized controlled trials published between January 1998 and December 2024, including 95,910 patients who underwent percutaneous coronary intervention and were randomly assigned to receive short-term DAPT or standard long-term DAPT.
• Based on the duration of DAPT, trials were grouped into five regimens: 1-month, 3-months, 6-months, 12-months, and > 12-months.
• The primary outcome was NACE, defined as a composite of death, MI, stroke, bleeding events, and stent thrombosis (ST); secondary outcomes were the individual components of NACE.

TAKEAWAY:

• The 1-month regimen of DAPT was associated with a significantly lower risk for NACE than the 3-month (risk ratio [RR], 0.74; 95% CI, 0.58-0.93), 6-month (RR, 0.63; 95% CI, 0.50-0.80), and > 12-month (RR, 0.67; 95% CI, 0.51-0.87) regimens.
• The risks for death, stroke, and ST did not differ significantly between the groups. However, the risk for MI was significantly higher with the 1-month regimen than with the > 12-month regimen (RR, 1.53; 95% CI, 1.02-2.30).
• The 1-month regimen was associated with a significantly reduced risk for bleeding events compared with the 12-month (RR, 0.57; 95% CI, 0.40-0.83) and > 12-month (RR, 0.47; 95% CI, 0.29-0.77) regimens.
• Additional analysis showed that the absolute reduction in the risk for bleeding with the 1-month regimen of DAPT was substantially greater than the absolute increase in the risk for MI.

IN PRACTICE:

“This indicates that the clinical impact of altering DAPT duration is more pronounced for bleeding complications than for MI. Although 1-month DAPT was associated with a more favorable NACE profile, this benefit was largely driven by reduced bleeding, alongside a signal toward increased MI risk compared with longer regimens, particularly beyond 12 months,” the researchers wrote.

SOURCE:

The study was led by Toshiharu Fujii, MD, Cardiovascular Medicine, Tokai University School of Medicine in Isehara, Japan. It was published online on June 1 in Heart.

LIMITATIONS:

MI and bleeding differed in clinical severity but were equally weighed within NACE, potentially overestimating the net clinical benefit of shorter DAPT. Bleeding outcomes, especially less severe events, were prone to detection bias in open-label trials. The study did not provide detailed information on antiplatelet strategies after DAPT.

DISCLOSURES:

The authors reported that they did not receive any specific funding for this research from public, commercial, or not-for-profit funding agencies. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.