Background: Left ventricular thrombus (LVT) remains a well-recognized complication following myocardial infarction (MI). Whilst vitamin K antagonists (VKAs) have traditionally been the cornerstone of management, direct oral anticoagulants (DOACs) have been increasingly utilized despite limited data to support this. We sought to perform an up-to-date meta-analysis of all randomized controlled trials (RCTs) comparing DOACs to VKAs for LVT resolution. Methods: A systematic search of major scientific databases was performed to identify RCTs published until May 2025. The primary efficacy endpoint was complete LVT resolution at 3 months. The risk ratio (RR) and 95% confidence intervals (CIs) of the individual RCTs were pooled via the inverse-variance method and random-effects model. Results: Seven RCTs involving 554 patients with a mean age of 54 years were included in the meta-analysis. At 3 months, there was no difference in the rate of LVT resolution between those in the DOAC arm and the warfarin arm (86% vs. 81%, RR 1.01 [95%CI 0.93–1.10], p = 0.76). There was low heterogeneity at I² = 15%. There was no difference in major or clinically significant bleeding or in the composite of stroke or thromboembolic complications, although the 95%CIs were wide. Conclusions: DOACs appear to be comparable to warfarin in achieving LVT resolution at 3 months. These findings support the consideration of DOACs as alternatives to VKAs in selected patients for LVT resolution. Further adequately powered trials and head-to-head comparisons between DOACs are required to confirm their safety.

For nearly two decades, 12 months of dual antiplatelet therapy (DAPT) after acute coronary syndrome (ACS) has been the standard recommendation. Recent evidence suggests that abbreviated DAPT durations may reduce bleeding without compromising ischemic protection in selected patients. This review synthesizes randomized controlled trials, meta-analyses, and guideline updates published between 2023 and 2025, evaluating abbreviated DAPT strategies after ACS with percutaneous coronary intervention. Immediate aspirin withdrawal after PCI increased early stent thrombosis in NEO-MINDSET and STOPDAPT-3. One-month DAPT followed by ticagrelor monotherapy reduced bleeding without increasing ischemic events in ULTIMATE-DAPT and T-PASS. Three-month strategies demonstrated the most consistent safety profile, with TWILIGHT showing 50% bleeding reduction without increased death, myocardial infarction, or stroke (noting that TWILIGHT included 35% chronic coronary syndrome patients). Clopidogrel monotherapy after abbreviated DAPT increased myocardial infarction in STOPDAPT-2 ACS, highlighting the importance of potent P2Y12 inhibition. Meta-analyses confirmed bleeding reductions with early P2Y12 inhibitor monotherapy across broader populations, though benefits were more pronounced in East Asian cohorts. Abbreviated DAPT strategies offer personalized alternatives to standard 12-month therapy. Three-month DAPT followed by ticagrelor monotherapy represents a reasonable and evidence-supported strategy in selected patients with ACS. Risk stratification tools and individual patient factors should guide therapy duration decisions.

P2Y12-inhibitor monotherapy after abbreviated dual antiplatelet therapy (DAPT) reduces bleeding after percutaneous coronary intervention, but whether aspirin can be stopped after one month rather than three remains uncertain. We reconstructed time-to-event data from published Kaplan-Meier or cumulative-incidence curves of 11 randomised trials (37,443 patients) using the Guyot algorithm, grouped trials by aspirin-withdrawal timing, and analysed within-trial monotherapy-versus-continued-DAPT effects using stratified Cox regression and random-effects meta-analysis across 0 to 30, 30 to 90, and 90 to 360-day intervals. Reconstructed event totals matched published totals exactly for all 12 curves, and reconstructed hazard ratios agreed with published estimates to within 2.2%. Monotherapy approximately halved major or minor bleeding (hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.44–0.59). One-month and three-month withdrawal produced comparable ischaemic-composite effects (risk ratio 0.88, CI 0.75–1.03, and 0.92, CI 0.74–1.15); these trials were not randomised against one another, so comparable estimates do not establish clinical equivalence. The only early excess arose with near-immediate withdrawal, driven entirely by NEO-MINDSET (0 to 30-day interval rate ratio 2.09, CI 1.33–3.28); excluding this trial left no ischaemic excess in the remaining trial. Myocardial infarction (HR 1.02, CI 0.82–1.28) and stent thrombosis (Peto odds ratio 1.19, CI 0.77–1.86) showed no overall excess. These hypothesis-generating findings, derived from reconstructed rather than true individual-participant data and from an indirect comparison across trials, suggest the relevant distinction may be immediate versus deferred aspirin withdrawal rather than one versus three months, though the early hazard rests on a single trial and requires independent replication.