Related Experiment Video
Updated: May 21, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Ultrashort Versus 1-Year Dual Antiplatelet Therapy Following Percutaneous Coronary Intervention: Meta-analysis of
Sheriff N Dodoo1, Benedicta Arhinful2, Sammudeen Ibrahim3
1Georgia Heart Institute, Northeast Georgia Medical Center, Gainesville, Georgia.
Insights
Ultrashort dual antiplatelet therapy (US-DAPT) of ≤1 month after percutaneous coronary intervention (PCI) significantly reduces net adverse clinical events and bleeding risk compared to standard DAPT. This shorter regimen is safe and effective, even when followed by single antiplatelet therapy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is standard after percutaneous coronary intervention (PCI).
- Optimal DAPT duration after PCI remains debated.
- This study evaluates ultrashort DAPT (US-DAPT; ≤1 month) versus standard DAPT (≥6 months).
Purpose of the Study:
- To compare the clinical utility of US-DAPT versus standard DAPT after PCI.
- To analyze outcomes of single antiplatelet therapy (clopidogrel or ticagrelor) following US-DAPT.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing US-DAPT and standard DAPT.
- Searched MEDLINE, Cochrane, Embase, and ClinicalTrials.gov databases up to May 2024.
- Primary endpoint was net adverse clinical events (NACE), a composite of major adverse cardiovascular/cerebrovascular events (MACCE) and clinically relevant bleeding (CRB).
Main Results:
- Seven RCTs involving 34,774 patients were analyzed.
- US-DAPT showed a 20% lower risk of NACE (OR, 0.80; P=.006) and a 47% reduction in CRB (OR, 0.53; P<.001) compared to standard DAPT at 12 months.
- US-DAPT also significantly reduced all-cause mortality (OR, 0.88; P=.04) and target vessel revascularization (TVR; OR, 0.87; P=.02) without increasing MACCE or stent thrombosis.
Conclusions:
- US-DAPT (≤1 month) is associated with lower NACE and bleeding risk after PCI compared to standard DAPT (≥6 months).
- This benefit is observed irrespective of subsequent single antiplatelet therapy choice (clopidogrel or ticagrelor).
- US-DAPT does not increase ischemic event rates, offering a potentially safer alternative for antithrombotic therapy post-PCI.
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; I 2 = 74%) and 47% reduction in CRB (OR, 0.53; 95% CI, 0.37-0.75; P < .001; I 2 = 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; I 2 = 0%) and TVR (OR, 0.87; 95% CI, 0.78-0.98; P = .02; I 2 = 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.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
23:33The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
