Optimal duration of dual antiplatelet therapy for coronary artery disease

Abstract

The optimal duration of dual antiplatelet therapy (DAPT) for stable coronary artery disease and acute coronary syndrome is a complex decision. We review current literature on standard duration DAPT versus short duration DAPT (6 months or shorter) or extended duration DAPT (>12 months) after percutaneous coronary intervention with drug-eluting stent placement, and prolonged treatment after 12 months in acute coronary syndrome. Current guideline recommendations are summarised, including the use of risk scores for ischaemic and bleeding risk assessment. Because of the limitations of current risk scores, we propose multiple patient-related and procedure-related factors for the ischaemic and bleeding risk assessment aiding in personalised DAPT duration.

Keywords: DAPT; Long-term; Short-term.

Fig. 1

a Flowchart illustrating the recommended duration of dual antiplatelet therapy in patients with stable coronary artery disease according to clinical and procedural risk factors for bleeding and ischaemia. b Flowchart illustrating recommended duration of dual antiplatelet therapy in patients with acute coronary syndrome (¹In patients with an extremely high bleeding risk, such as those scheduled for non-deferrable surgery with high bleeding risk, a minimum of one month of DAPT is mandatory. ACS acute coronary syndrome, DM diabetes mellitus, DAPT dual antiplatelet therapy, NSTEMI non-ST-segment elevation myocardial infarction, PCI percutaneous coronary intervention, SAPT single antiplatelet therapy, SCAD stable coronary disease, STEMI ST-segment elevation myocardial infarction)