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Updated: May 19, 2026
Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock
Published on: May 19, 2022
Association of DAPT duration with bleeding and ischemic outcomes after percutaneous coronary intervention with
Giuseppe Panuccio1,2,3, Nicole Carabetta4, Martina Sportelli4
1Department of Experimental and Clinical Medicine, Magna Graecia University, 88100, Catanzaro, Italy. panuccio@unicz.it.
Insights
Shorter dual antiplatelet therapy (DAPT) of one month or less after drug-coated balloon (DCB) angioplasty is linked to reduced bleeding events. Longer DAPT durations did not show an increased risk of ischemic events in patients undergoing DCB procedures.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pharmacology
Background:
- Drug-coated balloons (DCB) offer a "leave nothing behind" approach in percutaneous coronary intervention (PCI).
- Optimal duration of dual antiplatelet therapy (DAPT) following DCB angioplasty requires further investigation.
Purpose of the Study:
- To systematically review and meta-analyze the association between DAPT duration and clinical outcomes after DCB angioplasty.
- To assess the impact of DAPT duration on bleeding and ischemic events.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Inclusion of 52 studies with 18,856 patients.
- Analysis of bleeding (BARC criteria) and ischemic events (TLR, TVR, MACE) using meta-regression and subgroup analyses.
Main Results:
- Pooled mean DAPT duration was 133 days.
- A significant association was found between longer DAPT duration and increased bleeding rates (p < 0.001).
- One-month DAPT showed significantly lower bleeding rates compared to longer durations (0.9% vs. 4.6-5.3%; p = 0.01), with no increased ischemic risk.
Conclusions:
- Short DAPT (≤1 month) after DCB angioplasty is associated with reduced bleeding.
- No significant increase in ischemic events was observed across varying DAPT durations.
- Further randomized trials are needed to establish optimal DAPT strategies post-DCB.
Introduction:
Drug-coated balloons (DCB) represent a promising tool in percutaneous coronary intervention (PCI), enabling a "leave nothing behind" strategy. Evidence guiding the optimal duration of dual antiplatelet therapy (DAPT) after DCB angioplasty remains limited.
Methods:
A systematic review and meta-analysis was conducted according to PRISMA guidelines. Pooled DAPT duration was analyzed. The primary analysis assessed bleeding events (according to BARC criteria) and ischemic events including target lesion revascularization (TLR), target vessel revascularization (TVR), and major adverse cardiac events (MACE). Meta-regression and subgroup analyses were performed to assess the association between DAPT duration and clinical outcomes.
Results:
A total of 52 studies including 18,856 patients were analyzed. The pooled mean DAPT duration after DCB angioplasty was 133 days (95% CI 92-174). The overall rate of bleeding was 2.4% (95% CI 2.0-2.7). Meta-regression analysis showed a significant association between longer DAPT duration and higher bleeding rates (coefficient 0.0174; 95% CI 0.012-0.024; p < 0.001; p < 0.001). Subgroup analysis showed significantly lower rates of bleeding with 1-month DAPT regimen vs. 3-6 months and 6 months (0.9% vs 4.6% vs. 5.3%; p = 0.01). No significant association was observed between DAPT duration and ischemic outcomes, including TLR, TVR, or MACE (all p > 0.05).
Conclusions:
Short DAPT (≤ 1 month) following DCB angioplasty is associated with lower reported bleeding rates at the study level, while no ischemic signal was detected across DAPT durations. These hypothesis-generating findings support a rationale for tailoring antiplatelet therapy duration after DCB. Dedicated randomized trials are warranted to define the optimal DAPT strategy in the DCB setting.
