Key result
Shorter DAPT and de-escalation strategies reduce bleeding risk without compromising ischemic outcomes.
Why the study?
Despite accumulated evidence on dual antiplatelet therapy after percutaneous coronary intervention, the optimal antiplatelet strategy including the ideal agent, combination, or treatment duration remains actively debated.
What is the optimal antiplatelet strategy (agent, combination, and treatment duration) in patients with ACS or CCS undergoing PCI?
What is the optimal antiplatelet strategy (agent, combination, and treatment duration) in patients with ACS or CCS undergoing PCI?
This review highlights the evolution of DAPT strategies in PCI patients, emphasizing the recent shift towards bleeding-reduction strategies such as short DAPT, P2Y12 monotherapy, and de-escalation.
Supports individualized DAPT to reduce bleeding after PCI; leaves open the optimal regimen for ACS and CCS.
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor has been the mainstay of therapy for acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) following percutaneous coronary intervention (PCI) for more than two decades. Over this period, numerous trials have evaluated different antiplatelet strategies, initially focusing on more effective and prolonged regimens, and more recently on decreasing the intensity or duration of DAPT. Despite a wealth of accumulated evidence, the optimal antiplatelet strategy – including the ideal agent, combination, or treatment duration - remains a subject of active debate. This review summarizes the evolution of antiplatelet therapy, with particular emphasis on randomized controlled trials of DAPT in patients with ACS or CCS undergoing PCI.
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Simonsson et al. (2026) conducted a review in Coronary Artery Disease. Dual antiplatelet therapy (DAPT) vs. Alternative antiplatelet strategies (monotherapy, short duration, de-escalation) was evaluated. The optimal dual antiplatelet therapy strategy remains individualized, with recent evidence shifting toward reducing bleeding risk through shorter DAPT durations, de-escalation, or P2Y12 inhibitor monotherapy.
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