Efficacy and safety of dual anti-platelet aggregation short post-pharmacologic stent

Main Article Content

Aurelio Alejandro Ramírez-Delgadillo https://orcid.org/0009-0000-4696-7354
Leonardo Ramírez-De La Cruz https://orcid.org/0009-0007-0631-3007
Cesar Emiliano Jiménez-Limón https://orcid.org/0009-0001-0227-7009
Diego Alejandro Ruiseco-Chenhalls https://orcid.org/0009-0008-0877-615X
Cesar David Montes-González https://orcid.org/0009-0000-0954-5283
Gabriel Sebastián Alonso-Limón https://orcid.org/0009-0009-2618-2897

Keywords

Drug-Eluting Stents, Duration of Therapy, Hemorrhage, Thrombosis, Dual Antiplatelet Therapy

Abstract

The objective of this systematic review is to evaluate the efficacy and safety of short-duration dual antiplatelet therapy (< 6 months) compared with prolonged therapy (> 12 months) following drug-eluting stent implantation. A systematic search was conducted in databases such as PubMed and Google Scholar for articles published between 2019 and 2025, focusing on randomized clinical trials, observational studies, and recent meta-analyses. The primary outcomes analyzed were major ischemic events (cardiovascular death, myocardial infarction, stent thrombosis), major bleeding, and all-cause mortality. Available evidence demonstrates that short-duration dual antiplatelet therapy is non-inferior to prolonged therapy in preventing major adverse cardiovascular events and is consistently associated with a significant reduction in the risk of major bleeding. This strategy offers a superior net clinical benefit when an individualized de-escalation approach is applied, particularly with the use of new-generation drug-eluting stents, supporting the abbreviated regimen as a viable recommendation and, for many patients at high bleeding risk, the preferred option. These findings underscore the importance of integrating ischemic-bleeding risk profiles into personalized therapeutic decision-making.

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References

1. Soleimani, H., Karimi, E., Mahalleh, M. et al. Abbreviated dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 25, 343 (2025). https://doi.org/10.1186/s12872-025-04765-x

2. Park BW, Lee BH, Ahn HW, et al. Comparison of 3- to 6-month versus 12-month dual antiplatelet therapy after coronary intervention using the contemporary drug-eluting stents with ultrathin struts: the HOST-IDEA randomized clinical trial. Circulation. 2023;148(2):118–29. Disponible en: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064264

3. Ghafoor AM, Naksuk N, Al-Otaibi M, et al. One‐year outcomes of short‐term dual antiplatelet therapy following percutaneous coronary intervention with drug‐eluting stents: a meta‐analysis of randomized clinical trials. PubMed Central. 2025. doi: 10.1002/ccd.70163. Disponible en: https://doi.org/10.1002/ccd.70163

4. Jiménez-Díaz C, Galiñanes P, Sabaté M. et al. Tratamiento antiagregante de muy corta duración tras la ICP y nuevos SLF: metanálisis de 5 estudios aleatorizados. Revista Española de Cardiología. 2021;74(2):140–48. doi: 10.1016/j.recesp.2020.03.013. Disponible en: https://www.revespcardiol.org/es-tratamiento-antiagregante-de-muy-corta-d-articulo-S0300893220301561

5. Mankerious, N., Megaly, M., Hemetsberger, R. et al. Short Versus Long-Term Dual Antiplatelet Therapy in Patients at High Bleeding Risk Undergoing PCI in Contemporary Practice: A Systemic Review and Meta-analysis. Cardiol Ther 12, 489–498 (2023). https://doi.org/10.1007/s40119-023-00318-5

6. Yin Y, Chen Y, Lu Y, et al. Duration of dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent: systematic review and network meta-analysis. The BMJ. 2019;365:l2222. doi: 10.1136/bmj.l2222. Disponible en: https://www.bmj.com/content/365/bmj.l2222

7. Buisán Esporrín C. DAPT abreviada frente a prolongada en pacientes de alto riesgo hemorrágico. Cardiología Hoy - Sociedad Española de Cardiología (SEC). 2025. Disponible en: https://secardiologia.es/blog/15973-dapt-abreviada-frente-a-prolongada-en-pacientes-de-alto-riesgo-hemorragico

8. Li Y, Ma X, Zhai Y, et al. Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention for acute coronary syndrome in the modern drug-eluting stent era: a systematic review and network meta-analysis. Front Cardiovasc Med. 2023;10:1234500. Disponible en: https://doi.org/10.3389/fcvb.2023.1234500

9. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720-3826. Disponible en: https://doi.org/10.1093/eurheartj/ehad191

10. Liu J, Liu Y, Wang G, et al. Efficacy and safety of extended dual antiplatelet therapy beyond 12 months after percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials. Front Cardiovasc Med. 2023;10:1189433. Disponible en: https://doi.org/10.3389/fcvb.2023.1189433

11. Bainey KR, Marquis-Gravel G, MacDonald BJ, et al. Short dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk patients: systematic review and meta-analysis. PLoS One. 2023;18(9):e0291061. Disponible en: https://doi.org/10.1371/journal.pone.0291061

12. Li Y, Zhao R, Zhao Y, et al. Efficacy and safety of P2Y12 inhibitor monotherapy or dual antiplatelet therapy for patients with high ischemic risk after percutaneous coronary intervention: a systematic review and meta-analysis. J Am Coll Cardiol. 2023;81(1):610-632. Disponible en: https://doi.org/10.1016/j.jacc.2023.01.031

13. Dong J, Wang Y, Zhang L, et al. Use of dual antiplatelet therapy following ischemic stroke. Stroke. 2020;51(8):2482-2490. Disponible en: https://doi.org/10.1161/STROKEAHA.119.028400

14. Gao Y, Chen W, Pan Y, et al. Dual antiplatelet treatment up to 72 hours after ischemic stroke. N Engl J Med. 2023;389(4):320-331. Disponible en: https://doi.org/10.1056/NEJMoa2309137

15. Greco A, et al. Antithrombotic therapy for primary and secondary prevention of atherosclerotic cardiovascular disease. J Am Coll Cardiol. 2023;82(7):610-632. Disponible en: https://doi.org/10.1016/j.jacc.2023.07.025

16. Valgimigli M, Aboyans V, Angiolillo D, et al. Antithrombotic treatment strategies in patients with established coronary atherosclerotic disease. Eur Heart J Cardiovasc Pharmacother. 2023;9(5):462-496. doi: 10.1093/ehjcvp/pvad032. Disponible en: https://doi.org/10.1093/ehjcvp/pvad032

17. Verdoia M, Khedi E, Suryapranata H, et al. Very short dual antiplatelet therapy after PCI and new DES: a meta-analysis of 5 randomized trials. Rev Esp Cardiol (Engl Ed). 2021;74(2):140-8. Disponible en: https://jamanetwork.com/journals/jamacardiology/fullarticle/2824179

18. Mehran R, Baber U, Sharma SK, et al. Ticagrelor with or without aspirin in high-risk patients after PCI. N Engl J Med. 2019;381(21):2032–42. Disponible en: https://doi.org/10.1056/NEJMoa1908419

19. Hahn JY, Song YB, Oh JH, et al. Effect of P2Y12 inhibitor monotherapy vs dual antiplatelet therapy on cardiovascular events in patients undergoing percutaneous coronary intervention (SMART-CHOICE). JAMA. 2019;321(24):2428–37. Disponible en: https://doi.org/10.1001/jama.2019.8146

20. Valgimigli M, Frigoli E, Heg D, et al. Dual antiplatelet therapy after PCI in patients at high bleeding risk (MASTER DAPT). N Engl J Med. 2021;385:1643–55. Disponible en: https://doi.org/10.1056/NEJMoa2108749

21. Watanabe H, Morimoto T, Natsuaki M, et al. Clopidogrel monotherapy after 1 to 2 months of dual antiplatelet therapy vs 12 months of dual antiplatelet therapy in patients with acute coronary syndrome (STOPDAPT-2 ACS). JAMA Cardiol. 2022;7(4):407–17. Disponible en: https://doi.org/10.1001/jamacardio.2021.5244

22. Giacoppo D, Matsuda Y, Fovino LN, et al. Short dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy vs prolonged dual antiplatelet therapy after PCI with second-generation drug-eluting stents: systematic review and meta-analysis of randomized clinical trials. Eur Heart J. 2021;42(4):308–19. Disponible en: https://academic.oup.com/eurheartj/article/41/46/4415/5992317

23. Kinlay S, Young MM, Sherrod R, et al. Long-term outcomes and duration of dual antiplatelet therapy after coronary intervention with second-generation drug-eluting stents: the Veterans Affairs Extended DAPT Study. J Am Heart Assoc. 2023;12(2):e027055. Disponible en: https://doi.org/10.1161/JAHA.122.027055

24. Carvalho PEP, Gewehr DM, Nascimento BR, et al. Short-term dual antiplatelet therapy after drug-eluting stenting in patients with acute coronary syndromes: a systematic review and network meta-analysis. JAMA Cardiol. 2024;9(12):1094–1105. Disponible en: https://doi.org/10.1001/jamacardio.2024.3216

25. Apostolos A, Chlorogiannis D-D, Chrysostomidis G, et al. Efficacy and safety of thirty-day dual-antiplatelet therapy following complex percutaneous coronary intervention: a systematic review and meta-analysis. Journal of Cardiovascular Development and Disease. 2024;11(2):43. Disponible en: https://doi.org/10.3390/jcdd11020043

26. Pufulete M, Harris J, Pouwels K, et al. Real-world bleeding in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and prescribed different combinations of dual antiplatelet therapy (DAPT) in England: a population-based cohort study emulating a target trial. Open Heart. 2022;9:e001999. Disponible en: https://doi.org/10.1136/openhrt-2022-001999

27. Ticagrelor vs. clopidogrel en pacientes con SCA tratados de forma electiva - Sociedad Española de Cardiología [Internet]. [cited 2026]. Available from: https://secardiologia.es/blog/1863-ticagrelor-clopidogrel-pacientes-sca-tratados-forma-electiva

28. Bonaca MP, Bhatt DL, Cohen M, et al. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med. 2015;372(19):1791–1800. doi:10.1056/NEJMoa1500857

29. Thomas A, Gitto M, Shah S, Saito Y, Tirziu D, Chieffo A, et al. Antiplatelet Strategies Following PCI: A Review of Trials Informing Current and Future Therapies. J Soc Cardiovasc Angiogr Interv. 2023;2(3):100607. Disponible en: https://doi.org/10.1016/j.jscai.2023.100607