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Background Very short (≤ 3 months) duration of dual antiplatelet therapy (VSDAPT) has recently been proposed after percutaneous coronary intervention (PCI) with drug-eluting stent (DES). Objectives The aim of this systematic review and meta-analysis was to compare very short versus > 3 months' duration of dual antiplatelet treatment (DAPT) in patients undergoing PCI with DES, focusing on ischemic and bleeding events. Methods Three major databases (Medline, Cochrane Central Register of Controlled Trials, and Scopus) were screened for eligible randomized controlled trials (RCTs). The primary endpoint of our meta-analysis was the incidence of net adverse clinical events (NACE), as defined per trial, while secondary endpoints were major adverse cardiovascular events (MACE), all-cause and cardiovascular mortality, myocardial infarction, stroke, stent thrombosis, repeat revascularization, and major bleeding. ResultsWe included eight RCTs with a total of 41,204 patients; 20,592 patients were allocated to VSDAPT and the remaining 20,612 patients were randomized to a longer DAPT period. The abbreviated regimen significantly reduced NACE (odds ratio [OR] 0.83, 95% confidence interval [Cl] 0.74-0.95) and major bleeding (OR 0.71, 95% Cl 0.61-0.82), without affecting mortality or ischemic events (stroke, myocardial infarction, revascularization, and stent thrombosis). Conclusions VSDAPT significantly decreased the odds of NACEs and major bleeding by 17% and 29%, respectively, without increasing ischemic events. Thus, VSDAPT could be well tolerated and feasible after PCI with DES.

Background/Introduction Abbreviation of duration of dual antiplatelet therapy (DAPT) (one or three months) has been recently proposed, especially for high-bleeding risk patients, after percutaneous coronary intervention (PCI) with drug-eluting stent (DES). Purpose The purpose of the specific systematic review and meta-analysis was to compare 30-days versus longer duration (≥3 months) of DAPT in patients undergoing PCI with DES, focusing on ischemic and bleeding events. Methods Three databases were screened for eligible randomized-control trials. The primary endpoint was the incidence of net adverse clinical events (NACE), as they were defined in each trial. Secondary endpoints consisted of major adverse cardiovascular events (MACE), all-cause and cardiovascular mortality, myocardial infraction, stroke, stent-thrombosis, repeat revascularization and major bleeding. Results We included 4 RCTs with a total of 26,576 patients; 13,282 patients were grouped in 30-days DAPT, while the remaining 13,294 were allocated in longer period of DAPT. One-month of DAPT did not significantly reduce NACE (odds ratio [OR]: 0.87, 95% confidence intervals [Cl]: 0.74–1.03); however major bleedings were significantly reduced by 22% (OR: 0.78, 95% Cl: 0.65–0.94). Mortality or ischemic events (stroke, myocardial infraction, revascularization and stent thrombosis) were not affected. Conclusions Thirty-days DAPT did not significantly affect NACEs. However, odds of major bleedings were reduced significantly by 22%. Mortality and ischemic events did not differ between the two arms. Thus, 30-days DAPT could be considered as a safe and feasible after PCI with DES in selected patients, especially those in high-bleeding risk. Forthcoming RCTs could shed light on the optimal duration of DAPT. Funding Acknowledgement Type of funding sources: None.

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