Dual antiplatelet therapy after percutaneous coronary intervention: entering the final chapter?

In 2017, two focused updates from the European Society of Cardiology (ESC) and the American College of Cardiology/ American Heart Association (ACC/AHA) set new standards for the duration of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI): six months for patients with stable coronary artery disease (CAD) and 12 months for patients with an acute coronary syndrome (ACS) 1 .Special considerations were added for candidates to DAPT prolongation (i.e., >12 months) and candidates to DAPT shortening (i.e., one to three months) 1 .While the former include patients identified based on criteria of baseline risk and procedural complexity, the latter include an emerging and sizeable subgroup of patients at high bleeding risk (HBR), for which standardised definitions have recently been issued by the Academic Research Consortium 2 .Current indications on DAPT duration after PCI stem from the results of several DAPT studies published over the course of approximately 20 years 3 .In the investigational arms of the 13 available trials of short DAPT (Table 1), the P2Y 12 inhibitor -generally clopidogrel -was stopped at three or six months.