Dual antiplatelet therapy in coronary artery disease

Coronary artery disease encompasses a spectrum of clinical presentations caused by underlying coronary atherosclerosis. Acute manifestations of atherosclerotic disease occur when rupture/erosion of atherosclerotic plaque becomes substrate for platelet activation and aggregation, which have a central role in the formation and propagation of intracoronary thrombi. Therefore, antiplatelet therapy represents a standard of care in the primary and secondary prevention of CAD. Dual antiplatelet therapy (DAPT) typically refers to aspirin along with P2Y12 receptor inhibitor (clopi-dogrel, prasugrel or ticagrelor). Choice and duration of DAPT requires an individual approach and assessment of each patient, emphasizing the tailored antiplatelet treatment. This is largely driven by patient's clinical presentation (stable coronary artery disease or acute coronary syndrome), existing risk factors (ischemic vs. hemorrhagic risk), and following treatment plan (medical treatment, percu-taneous coronary intervention, or coronary artery bypass graft). In this review, we present the evidence supporting DAPT administration and therapy duration in different subpopulations of patients with CAD. Also, we will review these data in the context of current 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease, emphasizing the novelties from the present guidelines.