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Three-month versus twelve-month dual antiplatelet therapy after acute coronary syndrome: An updated meta-analysis of

Christopher Chinnatambi1, Abdul Rahaman Ottun1, Louise Sakowski2

  • 1Department of Internal Medicine, Piedmont Athens Regional Medical Center, Athens, GA, United States of America.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|August 21, 2026
PubMed

Insights

Shorter dual antiplatelet therapy (DAPT) of 3 months significantly reduces bleeding events in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI) without increasing ischemic risks. This abbreviated DAPT is a safe and effective strategy.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Optimal duration of dual antiplatelet therapy (DAPT) post-acute coronary syndrome (ACS) with percutaneous coronary intervention (PCI) is debated.
  • Advances in stent technology and P2Y₁₂ inhibitors necessitate re-evaluation of prolonged DAPT benefits.
  • Current evidence is insufficient to guide DAPT duration in ACS patients undergoing PCI.

Purpose of the Study:

  • To systematically review and meta-analyze randomized controlled trials (RCTs) comparing 3-month versus 12-month DAPT in ACS patients undergoing PCI.
  • To assess the impact of abbreviated DAPT on major adverse cardiovascular and cerebrovascular events (MACCE) and clinically relevant bleeding (CRB).
  • To evaluate the conclusiveness of evidence using trial sequential analysis (TSA).

Main Methods:

  • Systematic review and meta-analysis of RCTs exclusively enrolling ACS patients undergoing PCI.
  • Randomization to either 3-month or 12-month DAPT.
  • Coprimary outcomes: MACCE and CRB. Secondary outcomes: mortality, MI, stroke, stent thrombosis, TVR, and NACE.
  • Trial sequential analysis (TSA) for coprimary outcomes.

Main Results:

  • Seven RCTs with 17,515 patients were included.
  • 3-month DAPT showed no significant difference in MACCE compared to 12-month DAPT (RR, 0.96; 95% CI, 0.79-1.17).
  • 3-month DAPT significantly reduced CRB (RR, 0.62; 95% CI, 0.50-0.76), with an absolute risk reduction of 1.9%.
  • Net adverse clinical events (NACE) were lower with 3-month DAPT (RR, 0.81; 95% CI, 0.66-1.00).
  • TSA confirmed conclusive evidence for reduced bleeding and futility for ischemic benefit with abbreviated DAPT.

Conclusions:

  • Three-month DAPT followed by monotherapy is safe and effective in ACS patients treated with contemporary drug-eluting stents (DES).
  • Abbreviated DAPT significantly reduces bleeding events without increasing ischemic complications.
  • TSA supports abbreviated DAPT as a default strategy for appropriately selected ACS patients.
Abstract

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