Key result
Short DAPT followed by P2Y12 monotherapy is validated for HBR patients with new-generation DES.
Why the study?
Prolonged DAPT after PCI increases major bleeding risk and mortality, prompting the need to summarize evidence on evolving DAPT regimens with new-generation DES and propose a practical algorithm to personalize therapy based on bleeding and ischemic risks.
Does short-duration DAPT followed by P2Y12 inhibitor monotherapy balance ischemic and bleeding risks in patients undergoing PCI with new-generation DES compared to prolonged DAPT?
Does short-duration DAPT followed by P2Y12 inhibitor monotherapy balance ischemic and bleeding risks in patients undergoing PCI with new-generation DES compared to prolonged DAPT?
The paradigm of DAPT duration has shifted to personalized medicine, where short DAPT strategies are safe and effective for patients with new-generation DES, especially those at high bleeding risk.
Answers are grounded in this paper and cite their sources.
Shorter DAPT post-DES reduces bleeding without excess thrombosis; confirms consensus on individualized regimens after PCI.
Background. Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation is the cornerstone of treatment for acute coronary syndromes (ACS) and stable ischemic heart disease. Following PCI, dual antiplatelet therapy (DAPT) comprising aspirin and a P2Y12 inhibitor is mandatory to prevent early and late stent thrombosis. However, prolonged DAPT inherently increases the risk of major bleeding, which is independently associated with increased mortality. Objective. To summarize current evidence on the evolution of DAPT regimens in the context of new-generation DES technologies, and to propose a practical algorithm for interventional cardiologists to personalize antithrombotic therapy based on individual bleeding and ischemic risks. Methods. A narrative review of the literature indexed in PubMed, Scopus, and Web of Science (2015–2026), prioritizing guideline documents from the European Society of Cardiology (ESC), American College of Cardiology/American Heart Association (ACC/AHA), large randomized controlled trials (e.g., TWILIGHT, MASTER DAPT), and Academic Research Consortium for High Bleeding Risk (ARC-HBR) consensus statements. Results. First-generation DES were associated with delayed endothelialization and late stent thrombosis, necessitating prolonged DAPT (≥12 months). The advent of new-generation DES—featuring ultra-thin struts, biocompatible, or biodegradable polymers—has dramatically enhanced vascular healing. Consequently, recent landmark trials have validated short-DAPT strategies (1 to 3 months) followed by P2Y12 inhibitor monotherapy, particularly for patients at high bleeding risk (HBR). Ischemic and bleeding risk scoring systems, such as the PRECISE-DAPT and DAPT scores, alongside ARC-HBR criteria, have become essential tools for tailoring therapy duration. Conclusion. The paradigm of DAPT duration has shifted from a "one-size-fits-all" approach to highly personalized medicine. Modern DES technology allows for safe de-escalation and shortening of DAPT in vulnerable patients without compromising ischemic protection. Systematic risk stratification and a multidisciplinary approach remain vital in the contemporary catheterization laboratory.
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Mukhamedkali et al. (2026) conducted a review in Acute coronary syndromes and stable ischemic heart disease. Short-duration dual antiplatelet therapy (1 to 3 months) vs. Prolonged dual antiplatelet therapy (≥12 months) was evaluated. Shortening dual antiplatelet therapy to 1 to 3 months followed by P2Y12 inhibitor monotherapy is a validated strategy for patients with new-generation drug-eluting stents at high bleeding risk.
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