SHORTER dual antiplatelet therapy reduced bleeding without increasing major cardiovascular events in patients at high bleeding risk undergoing percutaneous coronary intervention, according to a systematic review and meta-analysis of 14 randomised clinical trials.
The optimal duration of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) in patients at high bleeding risk has remained uncertain because clinicians must balance the benefits of preventing ischaemic events against the risk of bleeding. The investigators evaluated whether abbreviated dual antiplatelet therapy regimens lasting 1–3 months were as safe and effective as standard treatment durations of 6–12 months.
The systematic review included randomised clinical trials identified through searches of PubMed, Embase, and the Cochrane Central Register of Controlled Trials from database inception until 26 October 2025. Eligible studies compared abbreviated and standard dual antiplatelet therapy in patients at high bleeding risk undergoing PCI who had no indication for oral anticoagulation. Pairwise meta-analysis compared abbreviated regimens with standard treatment, while a frequentist network meta-analysis compared 1 month, 3 months, and standard duration therapy.
Shorter Dual Antiplatelet Therapy Reduced Bleeding Events
The analysis included 14 randomised clinical trials involving 11,398 patients. The mean age was 74.7 years, ranging from 68.6–80.0 years. Women accounted for 39.1% of participants and men accounted for 60.9%.
Compared with standard dual antiplatelet therapy, abbreviated treatment significantly reduced major or clinically relevant nonmajor bleeding: risk ratio:0.71; 95% CI:0.55–0.92; p=0.009. Major bleeding was also reduced: risk ratio:0.76; 95% CI:0.59–0.99; p=0.04.
The risk of major adverse cardiovascular events did not differ between abbreviated and standard treatment: risk ratio:0.97; 95% CI:0.81–1.16; p=0.76. Similarly, no differences were observed in the individual components of the composite outcome, including cardiovascular death, myocardial infarction, and stroke.
Three-Month Regimens Showed Favourable Outcomes
The network meta-analysis also compared different abbreviated treatment durations. Although the single trial directly comparing 1 month and 3 months of dual antiplatelet therapy reported an increased risk of major adverse cardiovascular events with the 1-month regimen, the overall network estimate was not statistically significant: risk ratio:1.28; 95% CI:0.96–1.72.
The investigators concluded that abbreviated dual antiplatelet therapy was associated with a lower risk of bleeding than standard treatment in patients at high bleeding risk undergoing PCI. They also reported that, at least for 3-month regimens, shorter treatment was not associated with an increase in fatal or nonfatal ischaemic cardiovascular or cerebrovascular events compared with standard 6–12 month dual antiplatelet therapy.
Reference
Zito A et al. Dual antiplatelet therapy duration in patients at high bleeding risk: a systematic review and meta-analysis. JAMA Cardiol. 2026; doi: 10.1001/jamacardio.2026.1922.
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