Coronary disease & ACSMeta-analysis
Sex differences in dual antiplatelet therapy de-escalation strategies after percutaneous coronary intervention: a network meta-analysis
- Systematic review and network meta-analysis of randomised trials
- sex-stratified analysis
- treatment ranking
Authors' conclusion
Sex may influence the safety and efficacy of antiplatelet de-escalation strategies after PCI, particularly those involving the shortening of DAPT.
Study context
- Population
- Patients after percutaneous coronary intervention (PCI) without baseline indication for OAC, in RCTs reporting outcomes by sex
- Participants
- 71,272 patients · 20 RCTs
- Comparison
- Dual antiplatelet therapy (DAPT) de-escalation strategies vs standard DAPT, by sex
- Outcome
- Co-primary: trial-defined MACE and major bleeding
Pooled result
As reported in the abstract
MACE and major bleeding by sex
DAPT discontinuation vs Standard DAPTHazard ratio (95% CI)
MACE, females
0.86(0.75–0.98)
MACE, males
1.04(0.93–1.16)
major bleeding, males
0.60(0.44–0.82)
major bleeding, females
1.04(0.76–1.43)
- No interaction by sex for P2Y12 inhibitor switch or dose reduction vs standard DAPT: Major adverse cardiovascular events (MACE)
- Pint = .668
- No interaction by sex for P2Y12 inhibitor switch or dose reduction vs standard DAPT: major bleeding
- Pint = .858
Further pooled results
Treatment ranking by sex
- Aspirin discontinuation ranked best for most outcomes in females
- P2Y12 inhibitor switch to clopidogrel showed the best outcomes in males
Original publication
Sex differences in dual antiplatelet therapy de-escalation strategies after percutaneous coronary intervention: a network meta-analysis. Eur Heart J. Published 11 July 2025. doi:10.1093/eurheartj/ehaf473
Summarised from the published abstract; every number is checked against it