Abstract Body (Do not enter title and authors here): Introduction
Dual antiplatelet therapy (DAPT) for 12 months is recommended as the standard strategy following percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Short DAPT (1-3 months) followed by ticagrelor monotherapy is recommended for patients with high bleeding risk.

Objective
We performed a frequentist pairwise and network meta-analysis comparing the durations of DAPT using potent P2Y12 inhibitors (P2Y12i) (ticagrelor, prasugrel) in patients undergoing PCI for ACS.

Methods
PubMed, Scopus, and Cochrane CENTRAL databases were searched from inception through 5/2025 for randomized controlled trials (RCTs) comparing different potent P2Y12i-based DAPT durations. Outcomes of interest were major adverse cardiovascular events (MACE), net adverse clinical events (NACE; MACE + bleeding events), major bleeding, any bleeding, all-cause death, cardiac death, myocardial infarction, stroke, stent thrombosis, and target vessel revascularization. Frequentist random-effects pairwise and network meta-analysis was performed to calculate risk ratios (RRs) with 95% confidence intervals (CIs). DAPT strategies were ranked using P-scores.

Results
Seven RCTs with 23,054 patients comparing 3 strategies (1-month DAPT: 31.2%; 3-month DAPT: 18.6%; 12-month DAPT: 50.2%) were included. Short DAPT reduced the risk of NACE (RR 0.70; 95%CI 0.59-0.84; p<0.001; I²=51.2%), major bleeding (RR 0.42; 95%CI 0.33-0.54; p<0.001; I²=4%), and any bleeding (RR 0.51; 95%CI 0.43-0.61; p<0.001; I²=33.9%) compared with 12-month DAPT (Image 1). In the network comparison, 1-month and 3-month DAPT followed by potent P2Y12i monotherapy exhibited comparable P-scores and were identified as best to reduce NACE. 1-month DAPT was ranked to be the best strategy in reducing major and any bleeding.

Conclusion
In patients with ACS undergoing PCI, potent P2Y12i monotherapy after short DAPT for ≤3 months reduced NACE, major bleeding, and any bleeding without increasing other adverse outcomes. A 1-month DAPT duration followed by P2Y12i monotherapy showed the most favorable bleeding profile, while both 1-month and 3-month DAPT durations were effective in reducing NACE. Short-term DAPT is a recommended approach for patients at high bleeding risk.