We aimed to evaluate if a shorter course of DAPT followed by P2Y12 inhibitor monotherapy
is as effective as a 12-month course with fewer bleeding events. PubMed, Scopus, and
Cochrane Central were searched for randomized controlled trials of ACS patients comparing
dual antiplatelet therapy (DAPT) for 1 to 3 months followed by a P2Y12 inhibitor to
12-month DAPT. Quality assessment was performed with the Cochrane Collaboration risk
of bias assessment tool. Five randomized clinical trials were included, with a total
of 18,046 participants. Antiplatelet strategies were aspirin and P2Y12 inhibitor for
12 months compared with aspirin and P2Y12 inhibitor for 1 to 3 months followed by
P212 inhibitor alone. Patients randomized to 1 to 3 months of DAPT followed by P2Y12
inhibitor monotherapy had lower rates of major bleeding (1.42% vs 2.53%; OR 0.53;
95% CI 0.42-0.67; p < 0.001; I2 = 0%) and all-cause mortality (1.00% vs 1.42%; OR 0.71; 95% CI 0.53-0.95; p = 0.02;
I2=0%) with similar major adverse cardiac events (MACE) (2.66% vs 3.11%; OR 0.86; 95%
CI 0.71 – 1.03; p = 0.10; I2 = 0 %) compared to 12 months of DAPT. In conclusion, shorter course of DAPT for 1
to 3 months followed by P2Y12 inhibitor monotherapy reduces major bleeding and all
course mortality without increasing major adverse cardiac events compared with traditional
DAPT for 12 months.
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Article info
Publication history
Published online: May 25, 2021
Received in revised form:
April 11,
2021
Received:
February 25,
2021
Footnotes
Data: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
