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July 9, 2026Catheterization and Cardiovascular Interventions

Personalized Antithrombotic Therapy After Percutaneous Coronary Intervention: A Systematic Review of Risk‐Stratified Approaches

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Why the study?

Do personalized, risk-stratified antithrombotic regimens reduce bleeding without increasing ischemic risk compared to fixed 12-month DAPT in patients after PCI?

Population

>330,000 patients from 80 studies undergoing percutaneous coronary intervention, including…

Comparison

Personalized/risk-stratified antithrombotic… vs Fixed 12-month dual antiplatelet therapy (DAPT)

Design

Systematic_review

Key result

Personalized antithrombotic strategies, including ultra-short DAPT with P2Y12 monotherapy, substantially reduce bleeding by roughly 25%-65% compared to fixed 12-month DAPT after PCI.

Authors

TKTHIERRY KOCHKARIANAIAnis IsmailOCOmar Chaabo

Discussion

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Overview

Supports personalized DAPT post-PCI; extends evidence for risk-stratified and abbreviated regimens in HBR patients.

Key Points

  • The aim is to evaluate the effectiveness of personalized antithrombotic strategies compared to fixed dual antiplatelet therapy after PCI.
  • Systematic review of 80 studies involving over 330,000 patients.
  • Comparison of personalized versus fixed DAPT strategies and evaluation of bleeding and ischemic risk scores.
  • Assessment of antithrombotic therapy in high-bleeding-risk populations.
  • Personalized strategies significantly reduce bleeding risk by 25%-65%.
  • 1 to 3-month DAPT followed by P2Y12 monotherapy reduces major bleeding by up to 65% with no increase in MI.
  • Contemporary risk scores (ARC-HBR, PRECISE-DAPT) show moderate discrimination in predicting bleeding and ischemic risks.

Study Design

Type

Systematic Review (n=330,000)

Structured PICO

Do personalized, risk-stratified antithrombotic regimens reduce bleeding without increasing ischemic risk compared to fixed 12-month DAPT in patients after PCI?

P
Population
>330,000 patients across 80 studies evaluating personalized versus fixed antithrombotic therapy regimens after percutaneous coronary intervention.
I
Intervention
Personalized/risk-stratified antithrombotic therapy (including genotype-guided therapy, ultra-short DAPT ≤1 month with P2Y12 monotherapy, and 3-month DAPT)
C
Comparator
Fixed 12-month dual antiplatelet therapy (DAPT)
O
Outcome
Bleeding and ischemic outcomes (myocardial infarction, stent thrombosis, cardiovascular mortality)hard clinical

Personalized, risk-stratified antithrombotic regimens after PCI significantly reduce bleeding compared to fixed 12-month DAPT, supporting a shift away from one-size-fits-all therapy.

Cite This Study

KOCHKARIAN et al. (2026) conducted a systematic review in Percutaneous coronary intervention (PCI) (n=330,000). Personalized antithrombotic therapy (risk-stratified regimens) vs. Fixed 12-month dual antiplatelet therapy (DAPT) was evaluated on Bleeding and ischemic outcomes. Personalized antithrombotic strategies, including ultra-short DAPT with P2Y12 monotherapy, substantially reduce bleeding by roughly 25%-65% compared to fixed 12-month DAPT after PCI.

synapsesocial.com/papers/6a4f3bb72b81a944af57586bhttps://doi.org/10.1002/ccd.70733
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