Background Dual antiplatelet therapy (DAPT) has important implications for clinical outcomes in coronary disease. However, the optimal DAPT duration remains uncertain. Methods and results We searched four major databases for randomised controlled trials comparing long-term (≥12 months) with short-term (≤6 months) or shorter (≤3 months) DAPT in patients with coronary syndromes. The primary outcome was all-cause mortality. Secondary outcomes were any bleeding and major bleeding (safety), cardiac death, myocardial infarction, stent thrombosis, revascularisation and stroke (efficacy). Nineteen randomised controlled trials (n=60 111) satisfied inclusion criteria, 8 assessed ≤3 months DAPT. Compared with long-term (≥12 months), short-term DAPT (≤6 months) was associated with a trend towards reduced all-cause mortality (RR: 0.90, 95% CI: 0.80 to 1.01) and significant bleeding reduction (RR: 0.68, 95% CI: 0.55 to 0.83 and RR: 0.66, 95% CI: 0.56 to 0.77 for major and any bleeding, respectively). There were no significant differences in efficacy outcomes. These associations persisted in sensitivity analysis comparing shorter duration DAPT (≤3 months) to long-term DAPT (≥12 months) for all-cause mortality (RR: 0.91, 95% CI: 0.79 to 1.05). In subgroup analysis, short-term DAPT was associated with lower risk of bleeding in patients with acute or chronic coronary syndromes (RR: 0.66, 95% CI: 0.54 to 0.81 and RR: 0.53, 95% CI: 0.33 to 0.65, respectively), but higher risk of stent thrombosis in acute coronary syndrome (RR: 1.49, 95% CI: 1.02 to 2.17 vs RR: 1.25, 95% CI 0.44 to 3.58). Conclusion Our meta-analysis suggests that short (≤6 months) and shorter (≤3 months) durations DAPT are associated with lower risk of bleeding, equivalent efficacy and a trend towards lower all-cause mortality irrespective of coronary artery disease stability. All data relevant to the study are included in the article or uploaded as supplementary information. Data tables and analysis code can be made available upon reasonable request to the corresponding author.

中文翻译：

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双联抗血小板治疗的持续时间和冠心病的稳定性：一项包含 60 000 名患者的随机对照试验荟萃分析

背景双重抗血小板治疗（DAPT）对冠心病的临床结果具有重要意义。然而，最佳 DAPT 持续时间仍不确定。方法和结果 我们检索了四个主要数据库中的随机对照试验，比较冠状动脉综合征患者的长期（≥12 个月）与短期（≤6 个月）或更短（≤3 个月）DAPT。主要结局是全因死亡率。次要结局是任何出血和大出血（安全性）、心源性死亡、心肌梗死、支架内血栓形成、血运重建和中风（疗效）。19 项随机对照试验 (n=60 111) 满足纳入标准，其中 8 项评估的 DAPT ≤3 个月。与长期（≥12 个月）相比，短期 DAPT（≤6 个月）与全因死亡率降低的趋势相关（RR：0.90，95% CI：0.80 至 1.01），并且出血显着减少（RR对于大出血和任何出血，分别为 0.68、95% CI：0.55 至 0.83 和 RR：0.66、95% CI：0.56 至 0.77）。疗效结果没有显着差异。这些关联在比较较短持续时间 DAPT（≤3 个月）与长期 DAPT（≥12 个月）全因死亡率的敏感性分析中仍然存在（RR：0.91，95% CI：0.79 至 1.05）。在亚组分析中，短期 DAPT 与急性或慢性冠状动脉综合征患者出血风险较低相关（分别为 RR：0.66、95% CI：0.54 至 0.81 和 RR：0.53、95% CI：0.33 至 0.65） ，但急性冠状动脉综合征中支架内血栓形成的风险较高（RR：1.49，95% CI：1.02至2.17 vs RR：1.25，95% CI 0.44至3.58）。结论 我们的荟萃分析表明，无论冠状动脉疾病稳定性如何，较短（≤6 个月）和较短（≤3 个月）持续时间的 DAPT 与较低的出血风险、同等疗效和较低全因死亡率的趋势相关。与研究相关的所有数据都包含在文章中或作为补充信息上传。根据相应作者的合理要求，可以提供数据表和分析代码。