Meta-Analysis of Duration of Dual Antiplatelet Therapy in Acute Coronary Syndrome Treated With Coronary Stenting

Area of Science:

• Cardiology
• Pharmacology
• Clinical Trials

Background:

• Dual antiplatelet therapy (DAPT) is standard for acute coronary syndrome (ACS) patients.
• Longer DAPT duration increases bleeding risk.
• Optimizing DAPT duration is crucial for balancing efficacy and safety.

Purpose of the Study:

• To compare the efficacy and safety of a shorter DAPT course (1-3 months) followed by P2Y12 inhibitor monotherapy versus 12-month DAPT in ACS patients.
• To evaluate rates of major bleeding and major adverse cardiac events (MACE).

Main Methods:

• Systematic search of PubMed, Scopus, and Cochrane Central for randomized controlled trials.
• Included five RCTs with 18,046 participants comparing DAPT durations.
• Assessed study quality using the Cochrane Collaboration risk of bias tool.

Main Results:

• Shorter DAPT (1-3 months) followed by P2Y12 inhibitor monotherapy resulted in significantly lower rates of major bleeding (1.42% vs 2.53%) and all-cause mortality (1.00% vs 1.42%).
• Major adverse cardiac events (MACE) rates were similar between the shorter DAPT strategy and 12-month DAPT (2.66% vs 3.11%).
• No significant heterogeneity was observed across outcomes (I²=0%).

Conclusions:

• A 1- to 3-month DAPT course followed by P2Y12 inhibitor monotherapy is a safe and effective alternative to 12-month DAPT for ACS patients.
• This shorter regimen reduces bleeding and mortality without compromising cardiovascular protection.
• Findings support de-escalation of antiplatelet therapy in ACS management.