1-Month DAPT After Current-Generation DES PCI May Be Best for High-Bleeding-Risk Patients
1-Month DAPT After Current-Generation DES PCI May Be Best for High-Bleeding-Risk Patients
Source : Published in Heart, the official journal of the British Cardiovascular Society (BCS).
Medscape June 11, 2026
• A large network meta-analysis of 31 randomized trials involving 95,910 patients undergoing PCI evaluated the optimal duration of dual antiplatelet therapy (DAPT).
• Five DAPT strategies were compared:
• 1 month
• 3 months
• 6 months
• 12 months
• 12 months
• Primary outcome: Net Adverse Clinical Events (NACE), including death, myocardial infarction (MI), stroke, bleeding, and stent thrombosis.
Key Findings
• 1-month DAPT showed the lowest overall risk of NACE, significantly outperforming:
• 3-month DAPT (RR 0.74)
• 6-month DAPT (RR 0.63)
• 12-month DAPT (RR 0.67)
• Rates of:
• Death
• Stroke
• Stent thrombosis
were similar across all treatment durations.
• However, myocardial infarction risk was higher with 1-month DAPT compared with >12-month therapy:
• Bleeding risk was substantially lower with 1-month DAPT:
• 43% lower vs 12-month DAPT
• 53% lower vs >12-month DAPT
Clinical Interpretation
• The reduction in bleeding events with 1-month DAPT was greater in absolute terms than the increase in MI risk.
• These findings suggest that for many contemporary PCI patients, particularly those at higher bleeding risk, ultra-short DAPT may provide the most favorable overall risk-benefit balance.
• Longer DAPT durations continue to offer greater protection against MI, highlighting the importance of individualized treatment decisions based on ischemic versus bleeding risk.
Source: Published in Heart, June 2026.
Take-Home Message :
In the era of contemporary DES, 1-month DAPT may provide the most favorable profile in high-bleeding-risk patients, while
longer DAPT remains favored in high-risk ACS (e.g., STEMI, diabetes, multivessel disease, CKD, reduced LVEF, prior MI) and in complex PCI.
