Coronary disease & ACSMeta-analysis
P2Y12 inhibitor monotherapy after abbreviated dual antiplatelet therapy following percutaneous coronary intervention: a meta-analysis
- Systematic review and meta-analysis of randomised trials
- pairwise random-effects meta-analysis
- network meta-analysis
Authors' conclusion
Aspirin discontinuation at either ≤1 or 3 months with continued P2Y12 inhibitor monotherapy is associated with similar MACE, lower bleeding, and lower NACE compared with continued DAPT. Discontinuation within the first month may confer additional bleeding benefit, but at the cost of excess stent thrombosis, particularly in patients at higher ischaemic risk.
Study context
- Population
- Patients undergoing percutaneous coronary intervention (PCI)
- Participants
- 37,443 patients · 11 RCTs
- Comparison
- Aspirin discontinuation at ≤1 month or 3 months vs 12-month dual antiplatelet therapy (DAPT)
- Outcome
- Major adverse cardiovascular events (MACE)
Pooled result
As reported in the abstract
Each group vs 12-month DAPTRelative risk (95% CI)
≤1 month
1.01(0.85–1.20)
3 months
0.95(0.67–1.36)
Further pooled results
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Major bleeding — ≤1 month vs 12-month DAPT | 0.46 (0.23–0.94) | P = 0.038 | |
| Major bleeding — 3 months vs 12-month DAPT | 0.59 (0.39–0.89) | P = 0.027 | |
| Major or minor bleeding — ≤1 month vs 12-month DAPT | 0.43 (0.36–0.51) | P < 0.001 | |
| Major or minor bleeding — 3 months vs 12-month DAPT | 0.57 (0.53–0.60) | P = 0.005 | |
| Major or minor bleeding — ≤1 month vs 3 months · network meta-analysis, indirect comparison | 0.75 (0.57–0.99) | P = 0.044 | |
| 0.20.5125Relative risk (log scale) |
- Major or minor bleeding: P = 0.044 for interaction
Net adverse cardiovascular events (NACE)
- Significantly reduced with ≤1-month discontinuation; no significant differences between discontinuation timings
Safety
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Stent thrombosis, ACS (sensitivity analysis) · excess mainly with discontinuation <1 month | 1.81 (1.15–2.84) | P = 0.019 | |
| 0.20.5125Relative risk (log scale) |
Original publication
P2Y12 inhibitor monotherapy after abbreviated dual antiplatelet therapy following percutaneous coronary intervention: a meta-analysis. Eur Heart J. Published 5 June 2026. doi:10.1093/eurheartj/ehag381
Summarised from the published abstract; every number is checked against it