TOPLINE

In patients who underwent percutaneous coronary intervention (PCI) for acute coronary syndrome, short-duration dual antiplatelet therapy (DAPT) strategies followed by P2Y₁₂ inhibitor monotherapy were associated with better net clinical outcomes than standard 12‑month DAPT.

METHODOLOGY

• Researchers conducted a systematic review and network meta-analysis to compare the net benefits of early discontinuation of aspirin during DAPT with those of standard 12–month DAPT after PCI for acute coronary syndrome.
• The final analysis included 11 randomized trials published through November 2025 from multiple countries. The trials involved 34,283 patients (weighted mean age, 62.8 years; 24% women).
• Researchers compared four antiplatelet strategies — an aspirin-free strategy and DAPT durations of < 1 month, 1 month, and 3 months — with standard 12-month DAPT. Each of the first four strategies was followed by P2Y₁₂ inhibitor monotherapy.
• The primary endpoint was net adverse clinical events (NACE), as defined in each trial, at 12 months. This was a composite of ischemic and bleeding outcomes. Secondary endpoints included major bleeding and major adverse cardiovascular events.
• Researchers compared and ranked the strategies using pairwise and network meta-analysis, rating the certainty of the evidence as high for the main outcomes and low to moderate for others.

TAKEAWAY

• In pairwise analysis, aspirin-free and short-duration DAPT strategies followed by P2Y₁₂ inhibitor monotherapy were linked to a 23% lower risk for NACE than standard 12-month DAPT (risk ratio [RR], 0.77; 95% CI, 0.66-0.89), with moderate heterogeneity (I² = 45%).
• Aspirin-free and short-duration DAPT strategies were linked to a lower risk for major bleeding (RR, 0.46) and any bleeding (RR, 0.53) than standard 12-month DAPT.
• The researchers did not find a significant difference in the risk for major adverse cardiovascular events or other ischemic endpoints between the strategies.
• In the network meta-analysis, all individual antiplatelet strategies except the aspirin-free strategy were linked to a lower risk for NACE than standard 12-month DAPT. The < 1‑month strategy ranked highest for NACE and the 3‑month strategy ranked highest for ischemic outcomes.

IN PRACTICE

“While earlier aspirin discontinuation may be associated with greater net clinical benefit owing to reduced bleeding, 3-month DAPT may be associated with more favorable ischemic outcomes, highlighting the need to individualize DAPT duration according to bleeding and ischemic risk,” the researchers wrote.

SOURCE

The study was led by Kamil Bujak of Medical University of Silesia in Katowice, Poland. It was published online on June 26 in Heart.

LIMITATIONS

The analysis relied on trial-level data and could not stratify patients by ACS subtype, ischemic or bleeding risk, or ethnicity. The included trials varied in timing of randomization, ethnicity, P2Y₁₂ inhibitors tested, and dosing regimens. The aspirin-free and < 1-month DAPT strategies were each evaluated in only one trial.

DISCLOSURES

The authors did not report any specific source of funding for the study. One author reported receiving institutional research grant support from AstraZeneca, Janssen, and the Scott Mackie Foundation.

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