The optimal duration of dual antiplatelet therapy (DAPT) after coronary intervention remains an area of active investigation, particularly as advances in stent technology and secondary prevention strategies have prompted interest in shorter treatment courses. 

A network meta-analysis of randomized controlled trials published in the Heart compared clinical outcomes associated with five DAPT durations: 1 month, 3 months, 6 months, 12 months, and more than 12 months. Investigators evaluated net adverse clinical events (NACE), defined as a composite of death, myocardial infarction, stroke, stent thrombosis, and bleeding events.

The analysis included 31 randomized controlled trials involving 95,910 patients with ischemic heart disease. Individual ischemic and bleeding outcomes were also assessed, and treatment durations were ranked using surface under the cumulative ranking curve (SUCRA) methodology.

Findings

• One-month DAPT was associated with a lower risk of NACE compared with 3-month (RR, 0.74; 95% CI, 0.58–0.93), 6-month (RR, 0.63; 95% CI, 0.50–0.80), 12-month (RR, 0.64; 95% CI, 0.53–0.78), and >12-month DAPT (RR, 0.67; 95% CI, 0.51–0.87).
• No significant differences were observed in death, stroke, or stent thrombosis between 1-month DAPT and longer treatment durations.
• One-month DAPT was associated with a higher risk of myocardial infarction compared with DAPT lasting longer than 12 months (RR, 1.53; 95% CI, 1.02–2.30).
• Bleeding events occurred less frequently with 1-month DAPT than with 12-month DAPT (RR, 0.57; 95% CI, 0.40–0.83) and >12-month DAPT (RR, 0.47; 95% CI, 0.29–0.77).
• One-month DAPT achieved the highest SUCRA ranking for NACE (99.8), compared with 65.4 for 3 months, 24.6 for 6 months, 21.9 for 12 months, and 38.3 for >12 months.

The findings suggest that a 1-month DAPT strategy may provide the most favorable overall balance between ischemic and bleeding risks in patients with ischemic heart disease. However, the observed increase in myocardial infarction risk compared with very prolonged DAPT highlights the importance of individualized treatment decisions.