Dual Antiplatelet Therapy Across Clinical Indications — Ischemic Outcomes, Bleeding Risks, and Treatment Strategies: Scoping Review with ☸️SAIMSARA

To map the supplied evidence on DAPT across clinical indications, synthesizing its ischemic and bleeding outcomes, treatment duration, individualized selection, perioperative management, and implementation challenges, while distinguishing direct comparative evidence from observational and experimental findings. The review uses 1090 references and builds its evidence map from 5437 original studies with 42127523 total participants/sample observations (topic-deduplicated ΣN). The mapped evidence indicates that dual antiplatelet therapy is best understood as an indication- and time-dependent trade-off between ischemic protection and bleeding, not as a uniformly beneficial intervention. In selected coronary stent recipients, extending treatment beyond one year reduced stent thrombosis (0.4% versus 1.4%) but increased moderate or severe bleeding. Conversely, abbreviated regimens were associated with similar net adverse clinical events and less bleeding in patients at high bleeding risk, while early short-term DAPT after minor stroke or high-risk transient ischemic attack reduced recurrent stroke. These signals support individualized choice of agent, timing, and duration based on bleeding risk, platelet response, and CYP2C19 genotype. Future research should prioritize randomized comparisons of tailored DAPT strategies in peripheral, structural, and neurointerventional settings, where evidence remains largely observational.