P2Y12 Inhibitor Monotherapy after a Short Dual Antiplatelet Therapy Vs. 12-month Dual Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention: A Meta-analysis

Background

Dual Antiplatelet Therapy (DAPT) after PCI reduces the incidence of thrombotic events but increases the risk of bleeding, which is associated with a substantial and durable risk of death and could offset the benefits of a reduction in thrombotic events. P2Y12 inhibitor monotherapy after a short DAPT could be an option to reduce the risk of bleeding.

Methods

We carried out a systematic review following the PRISMA guidelines. We searched PubMed, EMBASE, and the Cochrane Library in Oct 2019. Two of us independently reviewed and selected eligible randomized trials. The Mantel-Haenszel method with the random-effect model was used to calculate the risk ratio with 95% confidence interval.

Results

Four randomized trials involving 20,706 patients undergoing PCI were included in the final analyses. Three of them were open-label trials, while the TWILIGHT trial was a double-blinded trial. Ticagrelor was used in two trials, and the other two trials did not select a particular P2Y12 inhibitor. P2Y12 Inhibitor monotherapy after a short DAPT significantly reduced the risk for major bleeding (defined as BARC type 3 or 5) compared to 12-month DAPT. There was no significant difference in all-cause mortality, cardiac death, myocardial infarction, stroke, or definite or probable stent thrombosis.

Conclusion

This meta-analysis showed a significantly lowered risk of major bleeding and similar benefits of P2Y12 inhibitor monotherapy after a short DAPT compared to 12-month DAPT in patients undergoing PCI.