Long-term (12 months) vs. short-term (<12 months) dual antiplatelet therapy post-percutaneous coronary intervention with drug-eluting stents: A critical appraisal and systematic review

Background:
A growing body of evidence supports short-term DAPT as safe and efficacious following PCI with DES. However, methodological criticism of RCTs has led to caution when translating results into clinical practice. This study aimed to critically appraise the methodological rigour of included studies and consolidate the evidence on the safety and efficacy of short-term DAPT.

Methods:
Medline, Cochrane Library and Embase were searched from inception until August 2022. The primary outcome was the methodological quality of published primary studies. Risk of bias was assessed using RoB 2.0 and the CASP tool. Evidence was rated for quality using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) score approach. Other endpoints were all-cause mortality and major bleeding.

Results:
Eighteen RCTs were included. Based on GRADE score, there was a moderate level of certainty that the reported results for both outcomes are probably close to the true effect. A total of 78% (14/18) of RCTs had a low risk of bias when assessing all-cause mortality and 61% (11/18) when assessing major bleeding. The CASP tool confirmed methodological rigour; however, only 33% (6/18) of studies were applicable beyond the studied populations. Compared with 12 months of DAPT, short-term DAPT was associated with a reduced risk of major bleeding [relative risk (RR): 0.69, 95% CI: 0.54-0.88, P=0.003, I2=45%] and trended towards a reduced risk in all-cause mortality (RR: 0.90, 95% CI: 0.79-1.01, P=0.08, I2=0%).

Conclusion:
With moderate certainty evidence, short-term DAPT appears safe and efficacious post-PCI with DES in the studied populations.