Are at Least 12 Months of Dual Antiplatelet Therapy Needed for All Patients With Drug-Eluting Stents?

of DAPT After Stent Implantation? Shorter Is SufficientThe optimal duration of DAPT after drug-eluting stent (DES) implantation was the basis of a recent systematic review and meta-analysis performed by Giustino and colleagues.12 Ten randomized trials and 32 135 patients were included in the analysis (Table 1).Short-duration DAPT, by definition 3, 6, or 12 months after the procedure, compared with long-duration DAPT, defined as 18 to 30 months after stent implantation, had a higher rate of definite or probable ST (odds ratio, 1.71; 95% confidence interval [CI], 1.26-2.32;P=0.001), particularly among patients with first-generation DES compared with those with second-generation DES (odds ratio, 3.94; 95% CI, 2.20-7.05;P int =0.008; Figure 1 and Table 2).Trials of 3-or 6-month DAPT discontinuation predominantly (≈75%) included patients who had received second-generation DES.In contrast, ≥12-month DAPT discontinuation trials had, on average, 50% second-generation DES.Short-term DAPT was associated with a significantly lower risk of clinically significant bleeding (odds ratio, 0.63; 95% CI, 0.52-0.75;P=0.001) and a numerically lower all-cause mortality rate (odds ratio, 0.87; 95% CI, 0.74-1.01;P=0.073).When the available data are considered collectively, for every ST event averted with long-duration DAPT, there would be 2.1 clinically significant bleeding events.9,11,[13][14][15][16][17][18][19][20]