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Short dual antiplatelet therapy in patients with high bleeding risk undergoing percutaneous coronary intervention: a systematic review and meta-analysis

Background The efficacy and safety of an abbreviated duration of dual antiplatelet therapy (DAPT) in patients with high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) (PCI-HBR patients) remain controversial. Methods The Cochrane Library, PubMed, EMBASE, and Ovid MEDLINE databases were searched. Studies that enrolled PCI-HBR patients as research subjects, compared different DAPT durations, and reported incidences of major adverse cardiac events (MACE) and net adverse clinical events (NACE) in PCI-HBR patients were obtained. The studies were stratified according to the DAPT duration (1, 3, and 6 months), and meta-analysis was subsequently performed. Results Nine studies (10 cohorts) were included in the meta-analysis. Compared with those who received DAPT for >1 month, PCI-HBR patients who received the 1-month DAPT regimen had comparable risks of NACE and MACE. Compared to those who received DAPT for >3 months, the risk of developing MACE in PCI-HBR patients who received the 3-month DAPT was not increased; however, the risk of ischemic stroke and stent thrombosis increased. Compared to those who received DAPT for >6 months, patients who received the 6-month DAPT had a reduction in the risk of major bleeding without an increase in NACE and MACE. Conclusions Shortening the DAPT regimen to 1 or 6 months did not increase the risk of MACE, and the 6-month DAPT regimen reduced the risk of major bleeding. However, the 3-month DAPT regimen increased the risk of ischemic stroke. Thus, shortened DAPT reduced the risk of MACE and bleeding, with a small absolute increase in ischemic strokes.