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Dual Antiplatelet Therapy Duration in Patients at High Bleeding Risk: A Systematic Review and Meta-Analysis

Andrea Zito1,2, Antonio Landi3, Deepak L Bhatt4

  • 1Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy.

JAMA Cardiology
|June 24, 2026
PubMed

Insights

For patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI), abbreviated dual antiplatelet therapy (DAPT) significantly reduces bleeding events. This shorter DAPT duration was not linked to an increased risk of major adverse cardiovascular events compared to standard therapy.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Optimal duration of dual antiplatelet therapy (DAPT) for patients at high bleeding risk (HBR) after percutaneous coronary intervention (PCI) is not well-defined.
  • Balancing the risk of bleeding against the prevention of ischemic events is crucial in this patient population.

Purpose of the Study:

  • To assess the safety and efficacy of shorter DAPT durations (1-3 months) compared to standard durations (6-12 months) in HBR patients undergoing PCI.
  • To evaluate the impact of abbreviated DAPT on bleeding events and major adverse cardiovascular events (MACE).

Main Methods:

  • A systematic review and meta-analysis of randomized clinical trials (RCTs) were conducted.
  • Searched databases included PubMed, Embase, and Cochrane Central Register of Controlled Trials.
  • Compared abbreviated (1-3 months) versus standard (≥6 months) DAPT durations, analyzing bleeding and MACE outcomes.

Main Results:

  • 14 RCTs with 11,398 HBR patients were included.
  • Abbreviated DAPT showed a significant reduction in major or clinically relevant nonmajor bleeding (MCRB) and major bleeding compared to standard DAPT.
  • No significant difference in MACE or its components was observed between abbreviated and standard DAPT regimens.

Conclusions:

  • Abbreviated DAPT (especially 3-month regimens) is associated with a lower risk of bleeding in HBR patients undergoing PCI.
  • Shorter DAPT durations do not appear to increase the risk of ischemic events compared to standard 6- to 12-month DAPT.
  • These findings support the use of abbreviated DAPT in select HBR patients to mitigate bleeding risk.
Abstract

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