Background: The efficacy and safety of ultra-short (≤1-month) dual antiplatelet therapy (DAPT) followed by antiplatelet monotherapy remain uncertain in acute coronary syndrome (ACS) patients.
Objective: To compare ultra-short versus standard-duration DAPT in ACS patients undergoing percutaneous coronary intervention (PCI).
Methods: We conducted a systematic review and meta-analysis of randomized controlled trials until November 30, 2025. Primary outcomes were major adverse cardiac and cerebrovascular events (MACCE), major bleeding, and net adverse clinical event (NACE). Prespecified subgroup analyses examined by ethnicity (East Asian vs. non-East Asian) and abbreviation strategy (intensive: ≤1-week DAPT or clopidogrel/aspirin monotherapy vs. moderate: ≥2-week DAPT, followed by ticagrelor/prasugrel monotherapy).
Results: Across 10 trials (n=29,232), ultra-short DAPT did not increase MACCE risk (hazard ratio [HR]: 1.06; 95% confidence interval [CI]: 0.93-1.20; P=0.38; I2=24%), with higher MACCE risk observed in ST-segment elevation myocardial infarction (STEMI) but not non-ST-segment elevation ACS (NSTE-ACS), and significantly reduced major bleeding (HR: 0.47; 95% CI: 0.35-0.64; P<0.00001; I2=44%), resulting in a net clinical benefit (HR: 0.83; 95% CI: 0.72-0.97; P=0.02; I2=61%). Bleeding reduction was more pronounced in East Asians (HR: 0.35; 95% CI: 0.25-0.49; P<0.00001; I2=0%) than non-East Asians (HR: 0.63; 95% CI: 0.43-0.93; P=0.02; I2=44%), with a significant interaction (P=0.02). The abbreviation strategy significantly modified outcomes (P for interaction=0.003): intensive abbreviation raised MACCE risk (HR: 1.37; 95% CI: 1.11-1.69; P=0.003; I2=0%), while moderate abbreviation had no statistically significant difference (HR: 0.96; 95% CI: 0.85-1.08; P=0.47; I2=0%). 5
Conclusions: In ACS patients undergoing PCI, ultra-short DAPT reduced bleeding without increasing ischemic events overall, although a signal of increased MACCE was observed in STEMI but not in NSTE-ACS. Bleeding reduction was greater in East Asians, while ≤1-week DAPT or clopidogrel/aspirin monotherapy may increase ischemic risk.
Editors
Editor-in-Chief
Harlan M. Krumholz, MD, SM, FACC
CME Editor
Ragavendra R. Baliga, MD
Author
Young-Hoon Jeong
Important Dates
Date of Release: September 14, 2026
Term of Approval/Date of CME/MOC Expiration: September 13, 2027