Extended Dual Versus Single Anti-Platelet Therapy Following Percutaneous Coronary Intervention: A Bayesian...

Area of Science:

• Cardiology and Interventional Cardiology
• Pharmacology and Therapeutics
• Clinical Trial Analysis and Meta-Research

Background:

• Current guidelines recommend dual antiplatelet therapy (DAPT) post-percutaneous coronary intervention (PCI), but optimal duration and transition strategies (e.g., to single antiplatelet therapy, SAPT) are debated.
• Limited comparative data exists on the safety and efficacy of extended DAPT versus SAPT, particularly concerning mortality and bleeding risks.

Purpose of the Study:

• To evaluate the clinical safety of dual antiplatelet therapy (DAPT) versus single antiplatelet therapy (SAPT) following percutaneous coronary intervention (PCI).
• To assess the impact of potential confounders on all-cause mortality in patients undergoing PCI.
• To provide comparative outcome data for guiding antiplatelet therapy decisions post-PCI.

Main Methods:

• A systematic literature search adhering to PRISMA guidelines was conducted across major databases (PubMed, Embase, Cochrane, ScienceDirect, Scopus) up to April 2025.
• Included randomized clinical trials (RCTs) and cohort studies were analyzed using Bayesian random-effects meta-analysis and meta-regression.
• Primary outcomes assessed were all-cause mortality and bleeding events, with secondary outcomes including net adverse clinical events (NACE) and major adverse cardiac and cerebrovascular events (MACCE).

Main Results:

• Dual antiplatelet therapy (DAPT) was associated with increased all-cause mortality (OR 1.25) and higher risks of net adverse clinical events (NACE) and various bleeding events (minor, major, BARC 2-5) compared to single antiplatelet therapy (SAPT).
• No significant differences were found between DAPT and SAPT for cardiac death, cardiovascular mortality, MACCE, myocardial infarction (MI), stent thrombosis, or stroke.
• Meta-regression indicated that higher baseline risks for conditions like dyslipidemia, hypertension, prior MI, and previous revascularization were associated with a greater mortality benefit from DAPT, yet increased adverse events within the DAPT cohort correlated significantly with higher all-cause mortality.

Conclusions:

• Extended dual antiplatelet therapy (DAPT) is linked to increased all-cause mortality, bleeding events, and net adverse clinical events (NACE) compared to single antiplatelet therapy (SAPT).
• While DAPT may offer benefits in high-risk patient populations, its associated adverse events significantly correlate with mortality, necessitating careful patient selection, monitoring, and risk-benefit assessment post-PCI.
• The findings underscore the need for individualized antiplatelet strategies following percutaneous coronary intervention (PCI).