This systematic review and network meta-analysis evaluated abbreviated DAPT (1–3 months) vs standard DAPT (6–12 months) in 11,398 high bleeding risk (HBR) patients undergoing PCI across 14 RCTs, with coprimary endpoints of major/clinically relevant nonmajor bleeding (MCRB) and MACE.
Abbreviated DAPT cut MCRB by 29% (RR 0.71; 95% CI 0.55–0.92; P=.009) and major bleeding by 24% (RR 0.76; 95% CI 0.59–0.99; P=.04) with no significant difference in MACE (RR 0.97; 95% CI 0.81–1.16; P=.76). A signal for higher MACE with 1-month vs 3-month DAPT was seen in one trial but was nonsignificant in the network estimate (RR 1.28; 95% CI 0.96–1.72).
- The 1-month vs 3-month comparison rests on a single trial, limiting confidence in that specific head-to-head estimate. - Patients on oral anticoagulation were excluded, restricting generalizability to an important real-world HBR subgroup. - Pooled results reflect trial-level definitions of HBR, which varied across studies.
For HBR patients post-PCI without anticoagulation needs, a 3-month DAPT course appears to cut bleeding without raising ischemic risk — consider it as a default over 6–12 months. Be cautious about shortening to 1 month; the current evidence is insufficient to confirm ischemic safety for that duration.
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