Sequential administration of abbreviated (up to one month) dual antiplatelet therapy and Ticagrelor monotherapy versus standard dual antiplatelet therapy after percutaneous coronary intervention: A meta-analysis

Abstract: OBJECTIVE: Dual antiplatelet therapy (DAPT), consisting of aspirin and a P2Y12 inhibitor, has been crucial for reducing ischemic events during the critical period following percutaneous coronary intervention PCI. The optimal duration of DAPT before transitioning to antiplatelet monotherapy however is debatable. This meta-analysis aims to evaluate the efficacy and safety of administering ticagrelor and aspirin for one month or less, followed by ticagrelor monotherapy for 12 months or more in patients undergoing PCI. METHODOLOGY: The search included studies with cohorts of patients who had undergone PCI and received DAPT with ticagrelor and aspirin. Efficacy and safety outcome measures were compared for abbreviated DAPT (Abv-DAPT) and long-term DAPT (L-DAPT) and expressed as risk ratios (RR) with 95% confidence intervals (CI). RESULTS: The consolidated population from three major trials included in the meta-analysis was 22,218, with a nearly equal distribution between the Abv-DAPT (N = 11,106) and L-DAPT (N = 11,112). Our results found no significant difference in the incidence of stroke (RR = 0.95 [0.70-1.29]; P = 0.76), major bleeding events (RR = 0.52 [0.27-1.0]; P = 0.05), myocardial infarction (RR = 1.15 [0.94-1.4]; P = 0.18), thrombosis (RR = 1.25 [0.86-1.83]; P = 0.25) and all-cause mortality (RR = 0.85 [0.68-1.07]; P = 0.16) between two arms. CONCLUSION: Shorter DAPT regimens could reduce bleeding complications without compromising on ischemic protection, particularly in patients with ACS. Future research should address the unresolved issues related to optimizing DAPT strategies and improve patient outcomes following PCI. Prospero Registration: NO-CRD42024536139.