{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T20:52:39Z","timestamp":1791924759935,"version":"4.3.4"},"reference-count":65,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Short-term (\u22646 months) dual antiplatelet therapy (DAPT) and DAPT de-escalation become attractive for patients with acute coronary syndrome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      A systemic search identified randomized controlled trials that included patients with acute coronary syndrome treated using (1) standard DAPT (12 months) with clopidogrel, prasugrel (standard\/low dose), or ticagrelor; (2) extended DAPT (\u226518 months); (3) short-term DAPT (\u22646 months) followed by P2Y\n                      <jats:sub>12<\/jats:sub>\n                      inhibitor or aspirin; (4) 12-month DAPT with unguided de-escalation from potent P2Y\n                      <jats:sub>12<\/jats:sub>\n                      inhibitors to low-dose potent P2Y\n                      <jats:sub>12<\/jats:sub>\n                      inhibitor or clopidogrel at 1 month; and (5) guided selection DAPT with genotype or platelet function tests. The primary efficacy outcome (major adverse cardiovascular events) was a composite of cardiovascular death, myocardial infarction, or stroke. The primary safety outcome was major or minor bleeding.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      This meta-analysis included 32 randomized controlled trials with 103 497 patients. While there were no differences in efficacy between short, unguided de-escalation and guided selection strategies, unguided de-escalation was associated with reduced risk of major adverse cardiovascular events compared with standard DAPT with clopidogrel or ticagrelor (hazard ratio [95% CI], 0.67 [0.49\u20130.93] and 0.68 [0.50\u20130.93]). Both short DAPT followed by P2Y\n                      <jats:sub>12<\/jats:sub>\n                      inhibitor and unguided de-escalation were associated with reduced risks in safety compared with other strategies, including guided selection (hazard ratio [95% CI], 0.66 [0.47\u20130.93] and 0.48 [0.33\u20130.71]). Short DAPT followed by a P2Y\n                      <jats:sub>12<\/jats:sub>\n                      inhibitor was associated with reduced risk of major bleeding and all-cause death compared with standard, extended DAPT (eg, versus DAPT with clopidogrel; hazard ratio [95% CI], 0.64 [0.42\u20130.97] and 0.60 [0.44\u20130.82]). By rankogram, unguided de-escalation strategy was the safest and most effective strategy in reducing major adverse cardiovascular events and major or minor bleeding while short DAPT followed by P2Y\n                      <jats:sub>12<\/jats:sub>\n                      inhibitor was ranked the best for major bleeding and all-cause death.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>\n                      In patients with acute coronary syndrome, unguided de-escalation was associated with the lowest risk of major adverse cardiovascular events and major or minor bleeding outcomes, while short DAPT followed by P2Y\n                      <jats:sub>12<\/jats:sub>\n                      inhibitor was associated with the lowest risk of major bleeding and all-cause death.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.123.013242","type":"journal-article","created":{"date-parts":[[2023,8,23]],"date-time":"2023-08-23T05:00:26Z","timestamp":1692766826000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":41,"title":["Short-Term DAPT and DAPT De-Escalation Strategies for Patients With Acute Coronary Syndromes: A Systematic Review and Network Meta-Analysis"],"prefix":"10.1161","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2487-8366","authenticated-orcid":true,"given":"Toshiki","family":"Kuno","sequence":"first","affiliation":[{"name":"Division of Cardiology, Montefiore Medical Center (T.K.), Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY."},{"name":"Division of Cardiology (T.K.), Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8781-0329","authenticated-orcid":true,"given":"Atsuyuki","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Medicine, Mount Sinai Beth Israel (A.W.), Icahn School of Medicine at Mount Sinai, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Shoji","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S.S., S.K.)."},{"name":"Duke Clinical Research Institute, Durham, NC (S.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9204-8551","authenticated-orcid":true,"given":"Tomohiro","family":"Fujisaki","sequence":"additional","affiliation":[{"name":"Department of Medicine, Mount Sinai Morningside and West (T.F.), Icahn School of Medicine at Mount Sinai, New York, NY."},{"name":"Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (T.F.)."},{"name":"Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (T.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Ueyama","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Emory University School of Medicine, Atlanta, GA (H.U.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5594-8072","authenticated-orcid":true,"given":"Hisato","family":"Takagi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Shizuoka Medical Center, Japan (H.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5910-3002","authenticated-orcid":true,"given":"Pierre","family":"Deharo","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, CHU Timone, Marseille, France (P.D., T.C.)."},{"name":"INSERM, INRA, C2VN (P.D., T.C.), Aix-Marseille Universit\u00e9, France."},{"name":"Facult\u00e9 de M\u00e9decine (P.D., T.C.), Aix-Marseille Universit\u00e9, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Cuisset","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, CHU Timone, Marseille, France (P.D., T.C.)."},{"name":"INSERM, INRA, C2VN (P.D., T.C.), Aix-Marseille Universit\u00e9, France."},{"name":"Facult\u00e9 de M\u00e9decine (P.D., T.C.), Aix-Marseille Universit\u00e9, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9485-0652","authenticated-orcid":true,"given":"Sripal","family":"Bangalore","sequence":"additional","affiliation":[{"name":"Leon H. 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