LAUSR

INTRODUCTION The ideal duration of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) is still unknown. In this meta-analysis, we aimed to compare very short-term (1-3 months), short-term (6 months), standard-term (12 months) and long-term (>12 months) DAPT durations for efficacy and safety. METHODS Overall DAPT comparisons were classified as "any shorter-term"/"any longer-term" DAPT. The primary outcome was a composite of major adverse cardiovascular events (MACE: non-fatal myocardial infarction, non-fatal stroke and cardiovascular death). The primary safety outcome was major bleeding. RESULTS Twenty-six studies comprising 103.394 patients were included. Compared with standard-term DAPT duration, very short-term DAPT duration with subsequent P2Y12 monotherapy resulted in similar risk of MACE (RR 1.06, 95% CI, 0.95-1.18, p = 0.26) and major bleeding (RR 1.61, 95% CI, 0.96-2.71, p = 0.07). Any longer-term compared with any shorter-term DAPT durations with subsequent aspirin monotherapy led to a significantly lower risk of MACE (RR 0.88, 95% CI, 0.81-0.96, p = 0.002), but a significantly higher risk of major bleeding (RR 1.81, 95% CI, 1.48-2.21, p < 0.00001). Only in the ACS subgroup receiving prasugrel or ticagrelor but not clopidogrel, any longer-term DAPT duration was associated with a significantly lower risk of MACE compared to any shorter-term DAPT duration (RR 0.84, 95% CI, 0.77-0.92, p = 0.0001). CONCLUSION DAPT may be shortened to 3 months in patients with low ischemic risk but high bleeding risk, whereas it may be extended to >12 months in case of high ischemic and low bleeding risk. The concept of P2Y12 inhibitor monotherapy, although promising, needs to be challenged. PROSPERO REGISTRATION NO CRD42020163719.