Sex Differences in the Safety and Efficacy of Different Durations of DAPT After PCI.
BACKGROUND: Randomized controlled trials (RCTs) have examined the clinical impact of abbreviating the duration of dual antiplatelet therapy (DAPT) and have reported outcomes in men and women. OBJECTIVES: The authors examined the safety and efficacy of different durations of DAPT following percutaneous coronary intervention (PCI) in men and women. METHODS: We searched Cochrane, Embase, MEDLINE, PubMed, Scopus, and Web of Science databases for RCTs that compared any 2 of 1, 3, 6, or 12 months of DAPT after PCI and reported outcomes in men and women. We performed a systematic review and network meta-analysis to examine sex-based differences in net adverse clinical events (NACE), major adverse cardiovascular events (MACE), and bleeding. RESULTS: Fifteen RCTs were included, comprising 44,610 men (74.7%) and 15,132 women (25.3%). No difference in NACE or MACE was observed between 1, 3, 6, or 12 months of DAPT in both sexes. In both men and women, 1 and 3 months of DAPT were each associated with lower risk of bleeding compared with 12 months of DAPT. In women, 3 months of DAPT was associated with a lower risk of bleeding compared with 6 months. Similar results were found in sensitivity analysis of acute coronary syndrome-only trials. CONCLUSIONS: No significant sex-based differences in NACE or MACE were observed with different durations of DAPT after PCI, while a lower bleeding risk was observed with shorter DAPT (1-3 months) among both sexes. This suggests that shorter DAPT may be preferred in both sexes following PCI, especially in those with high bleeding risk.
