Patients who had undergone percutaneous coronary intervention (PCI) with drug-eluting stents (DES) were included in this study.  Researchers searched for studies that compared the effects of optimal dual antiplatelet therapy (DAPT) (6-12 months) the following PCI in high bleeding risk (HBR) patients to S-DAPT (≤3 months), followed by aspirin or a P2Y 12 inhibitor as monotherapy. Major bleeding and myocardial infarction (MI) were this study’s primary endpoints of interest. Random-effects meta-analyses were carried out to calculate odds ratios with 95% CI.  In the primary analysis, a total of 16,848 participants were included from 6 randomized trials and 3 propensity-matched studies. When compared with L-DAPT (n=8,422), the incidence of major bleeding was lower with S-DAPT (n=8,426) [OR 0.68; 95% CI 0.51-0.89], whereas the incidence of MI did not differ significantly between the 2 groups [1.16; 0.94-1.44]. There was no discernible difference in the risks of death, stroke, or stent thrombosis (ST) between the groups receiving S-DAPT and those receiving L-DAPT. When separate analyses of propensity-matched studies were performed, these findings remained consistent. In conclusion, there was a numerically higher ST in the S-DAPT arm of patients with no indication for OAC [1.98; 0.86-4.58], although this difference did not reach statistical significance. Compared to L-DAPT, S-DAPT was shown to reduce bleeding in HBR patients undergoing DES implantation of the current generation. This was accomplished without an increase in the risk of death or MI. Evaluating the risks of late ST after 1 to 3 months of DAPT in patients at high risk for both ischemic and bleeding complications; Defining the SAPT of choice after 1 to 3 months of DAPT. There was a need for additional research to evaluate the risks of late ST after 1 to 3 months of DAPT in patients who were at high risk.

Source – sciencedirect.com/science/article/abs/pii/S000287032200076X