Shorter Dual Antiplatelet Therapy for Older Adults After Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis

Analysis (14 RCTs; n=19,102 older adults) found no differences in net adverse clinical events or major adverse CV events for 1, 3, 6, and 12 months of DAPT. However, 1 and 3 months were associated with lower bleeding risk vs 6 months, and 3 months with lower risk than 12 months.

SPS commentary:

The analysis included 14 RCTs that compared different durations of dual antiplatelet therapy, nine of which were exclusively conducted in Asia (the remainder were multinational). In terms of bleeding outcomes (note: article does not state if this was overall, clinically relevant, serious bleeding, for example):

  • One month of DAPT was associated with a lower risk of bleeding compared with 6 months of DAPT (RR 0.68 [95% CI 0.54-0.86]).
  • Three months of DAPT was associated with a lower risk of bleeding compared with 6 months of DAPT (0.50 [0.29-0.84]; P <0.001) and 12 months of DAPT (0.57 [0.45-0.71]; P=0.009).
  • The net clinical benefit favoured 3 months of DAPT for having a lower risk of bleeding while having a nonsignificant risk of MACE in comparison with 12 months of DAPT

The authors say their findings suggest that clinicians may consider abbreviating DAPT for older adults.

JAMA Network Open