Efficacy and safety of dual antiplatelet therapy de-escalation in East Asian individuals following percutaneous coronary intervention for acute coronary syndrome: a systematic review and meta-analysis.

Importantly, the only notable change in this RCT-only analysis was observed for minor bleeding events (BARC type 1).Whereas de-escalation was associated with a significantly lower risk of BARC 1 bleeding in the overall analysis (previously RR: 0.52, 95% CI: 0.32–0.86), the RCT-restricted analysis still showed a trend toward reduced minor bleeding with de-escalation but this difference was no longer statistically significant (RR: 0.65, 95% CI: 0.28–1.50, p = 0.311).This attenuation of significance is most likely due to the reduced sample size and statistical power after excluding the observational cohorts, rather than a true reversal of effect.Overall, the RCT-only sensitivity analysis confirms the robustness of our primary findings.

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