Association of DAPT duration with bleeding and ischemic outcomes after percutaneous coronary intervention with drug-coated balloons: a meta-analysis

Abstract Introduction Drug-coated balloons (DCB) represent a promising tool in percutaneous coronary intervention (PCI), enabling a “leave nothing behind” strategy. Evidence guiding the optimal duration of dual antiplatelet therapy (DAPT) after DCB angioplasty remains limited. Methods A systematic review and meta-analysis was conducted according to PRISMA guidelines. Pooled DAPT duration was analyzed. The primary analysis assessed bleeding events (according to BARC criteria) and ischemic events including target lesion revascularization (TLR), target vessel revascularization (TVR), and major adverse cardiac events (MACE). Meta-regression and subgroup analyses were performed to assess the association between DAPT duration and clinical outcomes. Results A total of 52 studies including 18,856 patients were analyzed. The pooled mean DAPT duration after DCB angioplasty was 133 days (95% CI 92–174). The overall rate of bleeding was 2.4% (95% CI 2.0–2.7). Meta-regression analysis showed a significant association between longer DAPT duration and higher bleeding rates (coefficient 0.0174; 95% CI 0.012–0.024; p < 0.001; p < 0.001). Subgroup analysis showed significantly lower rates of bleeding with 1-month DAPT regimen vs. 3–6 months and 6 months (0.9% vs 4.6% vs. 5.3%; p = 0.01). No significant association was observed between DAPT duration and ischemic outcomes, including TLR, TVR, or MACE (all p > 0.05). Conclusions Short DAPT (≤ 1 month) following DCB angioplasty is associated with lower reported bleeding rates at the study level, while no ischemic signal was detected across DAPT durations. These hypothesis-generating findings support a rationale for tailoring antiplatelet therapy duration after DCB. Dedicated randomized trials are warranted to define the optimal DAPT strategy in the DCB setting. Graphical Abstract