Background: The optimal duration of dual antiplatelet therapy is a matter of ongoing research.
Clinical studies are assessing the optimal duration with the most favourable risk to benefit
ratio. The efficacy of P2Y12 receptor inhibitors comparable to aspirin in preventing recurrent
ischaemic events in patients with coronary artery diseases.
Objectives: To investigate the outcomes of short-duration dual antiplatelet therapy after PCI with
early discontinuation of aspirin while maintaining patients on P2Y12 inhibitor through systematic
review and meta-analysis of available literature.
Methods: We systematically searched PubMed, Cochrane Central Register of Controlled Trials
(CENTRAL), and ClinicalTrials.gov. We included randomized controlled studies that measured
clinical outcomes of efficacy (mortality and ischaemic events) and safety (bleeding) of short and
standard-duration dual antiplatelet therapy. The protocol of this study was registered in the international
prospective register of systematic reviews PROSPERO registry (CRD42020171468).
Results: Four randomized controlled trials were included; GLOBAL LEADERS, SMARTCHOICE,
STOPDAPT-2, and TWILIGHT. The total number of patients was 29,089. The safety
outcomes showed a significant reduction in major bleeding events with short-duration dual antiplatelet
therapy; the risk ratio was 0.61 (95% CI 0.38-0.99; z=2,00, p=0.05). There was no difference
between short and standard-duration dual antiplatelet therapy regarding efficacy outcomes (all-
cause death, major adverse cardiovascular events, myocardial infarction, stroke, and stent thrombosis).
Conclusion: Short-duration dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy after
PCI is a feasible option and can be adopted, especially in patients with a high risk of bleeding.