Aspirin vs Clopidogrel vs Ticagrelor Monotherapy Compared to 12 Months of DAPT Following PCI; A Systematic Review and Meta-Analysis

Aspirin vs Clopidogrel vs Ticagrelor Monotherapy Compared to 12 Months of DAPT Following PCI; A Systematic Review and Meta-AnalysisDOI: 10.1016/j.jscai.2025.103158 ExternalLink BackgroundShort-term Dual Antiplatelet Therapy (DAPT) may reduce the risk of bleeding after Percutaneous Coronary Intervention (PCI) as compared to the standard 12 months of Dual Antiplatelet Therapy . However, it may not provide the same benefits against stent thrombosis and ischemic events. We aim to analyse the various recent Randomized Controlled trials (RCTs) to find the ideal drug among Aspirin or one of the PGY12 Inhibitors and time of initiation for monotherapy following Percutaneous Coronary Intervention with the lowest risk of adverse outcomes as compared to long term Dual Antiplatelet Therapy. MethodsRandomized Controlled trials comparing monotherapy with Ticagrelor, Aspirin or Clopidogrel to Dual Antiplatelet Therapy in adults undergoing Percutaneous Coronary Intervention were selected. The primary outcome was defined as Major adverse Cardiac and Cerebral events (MACCE) which is a composite of all cause death, myocardial infarction, stroke or clinically driven revascularization. The secondary outcome was clinically relevant bleeding. ResultsDrug Based analysis : short term Dual Antiplatelet Therapy was associated with a lower probability of MACCE (RR 0.90,95% CI 0.85, 0.96, p = 0.002) and Bleeding Risk (RR 0.66, 95% CI 0.55, 0.80, p < 0.0001). Ticagrelor was associated with the lowest risk for both MACCE and Bleeding. Duration based analysis : switching to monotherapy at 1 month or lesspresented a slightly higher bleeding risk but a lower risk of MACCE as compared to switching at 3 months. However both strategies had a lower risk for MACCE (0.91, 95% CI 0.85,0.98, p= 0.01) and bleeding (RR 0.67, 95% CI 0.54, 0.83, p = 0.0002) as compared to 12 months of Dual Antiplatelet Therapy. ConclusionsShort term Dual Antiplatelet Therapy is superior to12 months of Dual Antiplatelet Therapy, with Ticagrelor being thesafest drug started either at 1 or 3 months depending on the clinical situation.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.