---
title: "Optimal DAPT Duration After PCI with Contemporary DES: Network Meta-analysis of RCTs"
id: "plos-one-7-dual-antiplatelet-therapy-duration-after-percutaneous-coronary-intervention"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-7-dual-antiplatelet-therapy-duration-after-percutaneous-coronary-intervention"
content_type: "clinical_feed_article"
specialty: "Cardiology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357462"
published_at: "2026-09-02T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Optimal DAPT Duration After PCI with Contemporary DES: Network Meta-analysis of RCTs
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-7-dual-antiplatelet-therapy-duration-after-percutaneous-coronary-intervention
- **Specialty:** [Cardiology](https://medichelpline.com/clinical-feed/cardiology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357462)
- **Published At:** 2026-09-02T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This network meta-analysis pooled 28 randomized trials including 84,325 patients undergoing percutaneous coronary intervention (PCI) with second- or third-generation **drug-eluting stents (DES)** to compare abbreviated (<12 months), 12-month, and extended DAPT durations. - The systematic search covered PubMed, Embase, and Scopus from January 2008 through March 21, 2026; the protocol was prospectively registered on PROSPERO (CRD420261349664). - Primary efficacy and safety endpoints were trial-defined **major adverse cardiovascular events (MACE)** and **major bleeding**, respectively. - Relative effects were estimated by frequentist network meta-analysis using multivariate random-effects models; treatment ranking used SUCRA values. - Compared with 12-month DAPT, 1-, 3-, and 6-month strategies showed no significant difference in MACE: 1-month RR 1.03 (95% CI 0.88–1.22); 3-month RR 0.95 (95% CI 0.82–1.10); 6-month RR 1.06 (95% CI 0.88–1.27). - Shorter regimens were associated with significantly lower major bleeding: 1-month RR 0.59 (95% CI 0.42–0.82); 3-month RR 0.64 (95% CI 0.49–0.84); 6-month RR trended lower RR 0.68 (95% CI 0.46–1.00). - SUCRA rankings favored the **3-month DAPT** strategy for lowest ischemic risk (MACE) and the **1-month DAPT** strategy for lowest bleeding risk, with the 3-month regimen showing the most favorable overall profile across analyses. - Authors conclude that abbreviated DAPT (1–3 months) reduces bleeding without evidence of increased ischemic events versus 12 months, and propose 3 months as a pragmatic threshold, while cautioning interpretation due to study-level network meta-analysis limitations and lack of statistically significant efficacy differences. - Risk-of-bias, inconsistency, publication bias, and certainty of evidence were assessed using Cochrane RoB2, inconsistency tests, funnel plots/Egger-type tests, and GRADE, respectively; specific domain ratings and detailed trial-level data are reported in the manuscript and supporting information.
## Clinical Analysis & Structured Key Points
Dual antiplatelet therapy duration after percutaneous coronary intervention with contemporary drug-eluting stents: A systematic review and network meta-analysis of randomized trials | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Peer Review Reader Comments Figures Figures Abstract Background Despite widespread adoption of abbreviated ( 12 months) regimens. For presentation of relative treatment effects, the 12-month DAPT duration was used as the reference comparator in both the efficacy and safety networks. Outcomes: The primary efficacy and safety outcomes were major adverse cardiovascular events (MACE) and major bleeding, respectively, both as defined by the individual trials. Studies were excluded if they had missing clinical outcomes. Study Design: Eligible studies were parallel-group RCTs comparing at least two distinct DAPT durations, at least one of which was an abbreviated regimen. We excluded non-randomized studies, single-arm or historical-control designs, secondary analyses or post-hoc studies, and trials in which 12 months) [ 36 – 43 ] or ultrashort ( 12 months duration node was absent from the MACE network. The efficacy network therefore comprised four DAPT duration nodes (1-, 3-, 6-, and 12-month), with the 12-month DAPT used as the reference comparator ( Fig 3 ). Download: PNG larger image TIFF original image Fig 3. Network maps of dual antiplatelet therapy duration for major adverse cardiovascular events and major bleeding. Each node represents a dual antiplatelet therapy (DAPT) duration, and node size is proportional to the number of patients assigned to that treatment across included trials. Connecting lines indicate direct comparisons between treatment strategies. Line thickness reflects the number of trials contributing to each direct comparison. In panel A (major adverse cardiovascular events), the network includes four DAPT duration nodes (1 month, 3 months, 6 months, and 12 months). In panel B (major bleeding), an additional node (>12 months) is included based on available data from trials reporting bleeding outcomes. m = months. https://doi.org/10.1371/journal.pone.0357462.g003 The global inconsistency test indicated marginal inconsistency within the network (p = 0.05), with local side-splitting analysis identifying discrepancies in comparisons involving the 3-month DAPT strategy (12m vs. 3m, p = 0.01; 1m vs. 3m, p = 0.007) ( S2 Table ). However, subgroup analyses stratified by study setting demonstrated attenuation of the previously observed inconsistency, with no significant global inconsistency detected among multicountry trials (p = 0.94) or single-country trials (p = 0.34). After synthesizing direct and indirect evidence, no DAPT duration significantly differed from the 12-month reference regarding MACE: 1m vs. 12m (RR 1.03; 95% CI: 0.88–1.22), 3m vs. 12m (RR 0.95; 95% CI: 0.82–1.10), and 6m vs. 12m (RR 1.06; 95% CI: 0.88–1.27). Effect estimates were close to unity with confidence intervals spanning the null ( Fig 4 ). Despite these non-significant differences, SUCRA ranking analysis suggested the 3-month strategy had the highest probability of being the most effective (60.0%), while the 6-month duration was most likely to be the least effective (49.0%; Fig 5 ). Download: PNG larger image TIFF original image Fig 4. Forest plots comparing dual antiplatelet therapy durations for major adverse cardiovascular events. Forest plots show pairwise comparisons of dual antiplatelet therapy (DAPT) durations for major adverse cardiovascular events derived from the network meta-analysis. Blue squares represent individual trial estimates with corresponding 95% confidence intervals (horizontal lines). Green squares represent pooled direct estimates from conventional meta-analyses, and red squares represent pooled network estimates. The size of the squares is proportional to study weight. Risk ratios (RRs) are presented on a logarithmic scale; values 1 should be interpreted based on the direction of the comparison. The vertical reference line indicates no difference (RR = 1). m = months. https://doi.org/10.1371/journal.pone.0357462.g004 Download: PNG larger image TIFF original image Fig 5. Surface Under the Cumulative Ranking Curve (SUCRA)- based ranking probabilities of dual antiplatelet therapy durations for major adverse cardiovascular events. Bar chart showing the probability of each dual antiplatelet therapy (DAPT) duration strategy ranking at each position (best, second, third, or worst) for major adverse cardiovascular events (MACE), based on the network meta-analysis. Ranking probabilities were derived from the relative treatment effects across the network using a frequentist framework. Each bar represents the probability of a given DAPT duration (1 month, 3 months, 6 months, and 12 months) being ranked at a specific position. The “best” rank indicates the highest probability of achieving the most favorable outcome (lowest risk of MACE), whereas the “worst” rank indicates the least favorable outcome. m = months. https://doi.org/10.1371/journal.pone.0357462.g005 Sensitivity analyses demonstrated consistent findings across clinically relevant subgroups and endpoint definitions ( S3 Table and S2 Fig ). In trials enrolling exclusively patients with acute coronary syndrome (ACS; n = 8), no abbreviated DAPT duration was associated with a statistically significant difference in MACE compared to the 12-month duration, with 3-month regimen ranking highest (64.3%) and 12-month ranking lowest (7.3%). Similarly, in non-ACS-exclusive trials (n = 16), effect estimates remained non-significant, with 3-month DAPT again ranking highest (39.3%) and 6-month ranking lowest (13.9%), although with greater uncertainty in ranking. In the network of trials reporting composite (non-hard) MACE definitions that included stent thrombosis and revascularization (n = 20), findings were consistent, with effect estimates close to unity and 3-month DAPT demonstrating the highest probability of being most effective (61.1%), while 1-month ranked lowest (4.1%). In contrast, sensitivity analysis restricted to trials reporting standardized hard ischemic endpoints (death, myocardial infarction, and stroke; n = 4) yielded less precise estimates and variable ranking patterns, with 1-month DAPT ranking highest (64.0%) and 3-month lowest (11.7%); however, these findings should be interpreted cautiously given the limited number of studies and associated imprecision. Overall, these analyses support the robustness of the primary findings across varying clinical populations and MACE endpoint definitions. Safety outcome: Major bleeding All 28 trials reported major bleeding as a standalone outcome and were included in the safety analysis. The safety network included five DAPT treatment duration nodes: 1-month, 3-month, 6-month, 12-month (reference), and >12-month ( Fig 3 ). The bleeding network demonstrated strong consistency, with no evidence of global inconsistency (p = 0.74). Local side-splitting analyses did not identify any significant discrepancies between direct and indirect estimates. Shorter DAPT durations were associated with lower bleeding risk compared with the 12-month reference. Specifically, 1-month DAPT was associated with a significantly reduced risk of bleeding (RR 0.59, 95% CI: 0.42–0.82), as was 3-month DAPT (RR 0.64, 95% CI: 0.49–0.84). The 6-month strategy showed a similar trend (RR 0.68, 95% CI: 0.46–1.00), although this did not reach conventional statistical significance. In contrast, extended DAPT (>12 months) was not associated with a significant difference in bleeding risk (RR 0.89, 95% CI: 0.32–2.45) ( Fig 6 ). Download: PNG larger image TIFF original image Fig 6. Forest plots comparing dual antiplatelet therapy durations for major bleeding. Forest plots showing pairwise comparisons of dual antiplatelet therapy (DAPT) durations for major blee
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