Longer dual antiplatelet therapy duration after drug-coated balloon angioplasty was significantly associated with higher bleeding rates (coefficient 0.0174), with no difference in ischemic outcomes.
Meta-Analysis (n=18,856)
Does short DAPT (≤ 1 month) reduce bleeding without increasing ischemic events compared to longer DAPT in patients undergoing PCI with drug-coated balloons?
Short DAPT (≤ 1 month) after DCB angioplasty is associated with lower bleeding rates without an apparent increase in ischemic events, supporting tailored antiplatelet therapy.
Effect estimate: Coefficient 0.0174 (95% CI 0.012-0.024)
p-value: p=<0.001
Abstract Introduction Drug-coated balloons (DCB) represent a promising tool in percutaneous coronary intervention (PCI), enabling a “leave nothing behind” strategy. Evidence guiding the optimal duration of dual antiplatelet therapy (DAPT) after DCB angioplasty remains limited. Methods A systematic review and meta-analysis was conducted according to PRISMA guidelines. Pooled DAPT duration was analyzed. The primary analysis assessed bleeding events (according to BARC criteria) and ischemic events including target lesion revascularization (TLR), target vessel revascularization (TVR), and major adverse cardiac events (MACE). Meta-regression and subgroup analyses were performed to assess the association between DAPT duration and clinical outcomes. Results A total of 52 studies including 18,856 patients were analyzed. The pooled mean DAPT duration after DCB angioplasty was 133 days (95% CI 92–174). The overall rate of bleeding was 2.4% (95% CI 2.0–2.7). Meta-regression analysis showed a significant association between longer DAPT duration and higher bleeding rates (coefficient 0.0174; 95% CI 0.012–0.024; p 0.05). Conclusions Short DAPT (≤ 1 month) following DCB angioplasty is associated with lower reported bleeding rates at the study level, while no ischemic signal was detected across DAPT durations. These hypothesis-generating findings support a rationale for tailoring antiplatelet therapy duration after DCB. Dedicated randomized trials are warranted to define the optimal DAPT strategy in the DCB setting. Graphical Abstract
Panuccio et al. (2026) conducted a meta-analysis in Coronary artery disease (n=18,856). Dual antiplatelet therapy (DAPT) vs. Shorter vs longer duration was evaluated on Bleeding events (BARC >= 2) (Coefficient 0.0174, 95% CI 0.012-0.024, p=<0.001). Longer dual antiplatelet therapy duration after drug-coated balloon angioplasty was significantly associated with higher bleeding rates (coefficient 0.0174), with no difference in ischemic outcomes.