Optimal duration of dual antiplatelet therapy in ischaemic heart disease: a systematic review and network meta-analysis of randomised controlled trials
Authors' conclusion
1-month DAPT may offer the lowest risk balance between ischaemic and bleeding risks; however, these findings should be applied within an individualised, patient-specific risk management framework.
Study context
- Population
- Patients with ischaemic heart disease
- Participants
- 95,910 patients31 randomised controlled trials
- Comparison
- Dual antiplatelet therapy (DAPT) durations of 1 month, 3 months, 6 months, 12 months and >12 months
- Outcome
- Net adverse clinical events (NACE), a composite of death, myocardial infarction, stroke, stent thrombosis and bleeding events
Methodological detailssurface under the cumulative ranking
- Surface under the cumulative ranking
Pooled result
As reported in the abstract
Risk ratio (CI)
1-month DAPTvs 3-month DAPT
0.74(0.58–0.93)
1-month DAPTvs 6-month DAPT
0.63(0.50–0.80)
1-month DAPTvs 12-month DAPT
0.64(0.53–0.78)
1-month DAPTvs >12 month DAPT
0.67(0.51–0.87)
Further pooled results
| Outcome | Values | Risk ratio (CI) | |
|---|---|---|---|
| Death, myocardial infarction, stroke or stent thrombosisMyocardial infarction — 1-month DAPTvs >12 month DAPTHigher risk with 1-month DAPT | 1.53 (1.02–2.30) | ||
| 0.512Risk ratio (log scale) |
| Outcome | Values |
|---|---|
| SUCRA value for NACE | 1-month DAPT SUCRA 99.8 · 3-month DAPT SUCRA 65.4 · 6-month DAPT SUCRA 24.6 · 12-month DAPT SUCRA 21.9 · >12 month DAPT SUCRA 38.3 |
Death, myocardial infarction, stroke or stent thrombosis
- No significant differences in death, myocardial infarction, stroke or stent thrombosis with 1-month DAPT, except myocardial infarction vs >12 month DAPT
Safety
| Outcome | Risk ratio (CI) | |
|---|---|---|
| Bleeding events1-month DAPTvs 12-month DAPT | 0.57 (0.40–0.83) | |
| Bleeding events1-month DAPTvs >12 month DAPT | 0.47 (0.29–0.77) | |
| 0.20.5125Risk ratio (log scale) |
Original publication
Optimal duration of dual antiplatelet therapy in ischaemic heart disease: a systematic review and network meta-analysis of randomised controlled trials. Heart. Published 1 June 2026. doi:10.
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