Shorter vs. Standard Duration of Dual Antiplatelet Therapy in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Shorter vs. Standard Duration of Dual Antiplatelet Therapy in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Shorter vs. Standard Duration of Dual Antiplatelet Therapy in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis Mariana Ferreira Carvalho, Carolina Gonçalves, Adriana Vazão, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7557695/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Current guidelines recommend dual antiplatelet therapy (DAPT) for 12 months following percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients; however, prolonged DAPT increases bleeding risk. The optimal duration or strategy for DAPT, particularly in high bleeding risk (HBR) patients, remains unclear. This systematic review and meta-analysis comprehensively evaluated randomized controlled trials (RCTs) comparing short-duration (≤ 6 months) or early de-escalation strategies with standard-duration (12 months) DAPT in ACS patients undergoing PCI. Methods Following PRISMA guidelines, we systematically searched PubMed, Embase, Cochrane Library, Scopus, and ClinicalTrials.gov from January 2014 to March 2024. Only RCTs comparing short (≤ 6 months) or de-escalated DAPT versus standard 12-month therapy in ACS patients undergoing PCI were included. Primary outcomes were ischemic events (cardiovascular death, myocardial infarction, stroke) and bleeding events (BARC ≥ 3). Secondary outcomes included stroke, mortality, and stent thrombosis. Random-effects meta-analysis provided pooled risk ratios (RRs) and 95% confidence intervals (CIs), with heterogeneity assessed by I² and subgroup analyses conducted. Results Eight high-quality RCTs enrolling 28,979 patients were included. Short-duration or early de-escalation of DAPT significantly reduced bleeding risk (RR = 0.49; 95% CI: 0.32–0.75; I²=54.6%; p = 0.001) without increasing ischemic outcomes (RR = 0.95; 95% CI: 0.87–1.03; I²=0%; p = 0.20). Subgroup analyses showed significant risk reductions in stroke (RR = 0.77; 95% CI: 0.63–0.94), mortality (RR = 0.82; 95% CI: 0.71–0.94), and stent thrombosis (RR = 0.73; 95% CI: 0.57–0.95), all without significant heterogeneity (I²=0%). Conclusion In ACS patients undergoing PCI, shorter-duration (≤ 6 months) or early de-escalation of DAPT significantly reduces bleeding events and improves net clinical benefit without compromising ischemic safety. These findings strongly support tailored DAPT strategies in clinical practice, particularly for patients at high bleeding risk. Acute coronary syndrome Dual antiplatelet therapy Percutaneous coronary intervention Bleeding Ischemic events Meta-analysis Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7557695","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":515576190,"identity":"9f74de6a-16df-4e86-bd1c-e5e260492c15","order_by":0,"name":"Mariana Ferreira 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Dual antiplatelet therapy, Percutaneous coronary intervention, Bleeding, Ischemic events, Meta-analysis","lastPublishedDoi":"10.21203/rs.3.rs-7557695/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7557695/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003e Current guidelines recommend dual antiplatelet therapy (DAPT) for 12 months following percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients; however, prolonged DAPT increases bleeding risk. The optimal duration or strategy for DAPT, particularly in high bleeding risk (HBR) patients, remains unclear. This systematic review and meta-analysis comprehensively evaluated randomized controlled trials (RCTs) comparing short-duration (\u0026le;\u0026thinsp;6 months) or early de-escalation strategies with standard-duration (12 months) DAPT in ACS patients undergoing PCI.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e Following PRISMA guidelines, we systematically searched PubMed, Embase, Cochrane Library, Scopus, and ClinicalTrials.gov from January 2014 to March 2024. Only RCTs comparing short (\u0026le;\u0026thinsp;6 months) or de-escalated DAPT versus standard 12-month therapy in ACS patients undergoing PCI were included. Primary outcomes were ischemic events (cardiovascular death, myocardial infarction, stroke) and bleeding events (BARC\u0026thinsp;\u0026ge;\u0026thinsp;3). Secondary outcomes included stroke, mortality, and stent thrombosis. Random-effects meta-analysis provided pooled risk ratios (RRs) and 95% confidence intervals (CIs), with heterogeneity assessed by I\u0026sup2; and subgroup analyses conducted.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eEight high-quality RCTs enrolling 28,979 patients were included. Short-duration or early de-escalation of DAPT significantly reduced bleeding risk (RR\u0026thinsp;=\u0026thinsp;0.49; 95% CI: 0.32\u0026ndash;0.75; I\u0026sup2;=54.6%; p\u0026thinsp;=\u0026thinsp;0.001) without increasing ischemic outcomes (RR\u0026thinsp;=\u0026thinsp;0.95; 95% CI: 0.87\u0026ndash;1.03; I\u0026sup2;=0%; p\u0026thinsp;=\u0026thinsp;0.20). Subgroup analyses showed significant risk reductions in stroke (RR\u0026thinsp;=\u0026thinsp;0.77; 95% CI: 0.63\u0026ndash;0.94), mortality (RR\u0026thinsp;=\u0026thinsp;0.82; 95% CI: 0.71\u0026ndash;0.94), and stent thrombosis (RR\u0026thinsp;=\u0026thinsp;0.73; 95% CI: 0.57\u0026ndash;0.95), all without significant heterogeneity (I\u0026sup2;=0%).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eIn ACS patients undergoing PCI, shorter-duration (\u0026le;\u0026thinsp;6 months) or early de-escalation of DAPT significantly reduces bleeding events and improves net clinical benefit without compromising ischemic safety. These findings strongly support tailored DAPT strategies in clinical practice, particularly for patients at high bleeding risk.\u003c/p\u003e","manuscriptTitle":"Shorter vs. Standard Duration of Dual Antiplatelet Therapy in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 19:45:53","doi":"10.21203/rs.3.rs-7557695/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6ce2d410-d68f-440c-992a-1a440a4d97db","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-23T09:08:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 19:45:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7557695","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7557695","identity":"rs-7557695","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}