Antithrombotic therapy represents the mainstay of pharmacological treatments in patients with acute or chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI) [
]. Since the CURE study [
- De Servi S.
- Landi A.
- Savonitto S.
- et al.
Tailoring oral antiplatelet therapy in acute coronary syndromes: from guidelines to clinical practice.
J Cardiovasc Med. 2023; 24
], dual antiplatelet therapy (DAPT) consisting of aspirin and an oral P2Y12 inhibitor has represented the standard of care for acute coronary syndrome (ACS) or PCI patients due to the greater ischemic protection compared with aspirin alone. Current guidelines recommend 6 or 12 months as default DAPT durations in patients with CCS or ACS undergoing PCI, respectively [
- Mehta S.R.
- Yusuf S.
- Peters R.J.G.
- et al.
Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study.
Lancet. 2001; 358: 527-533
- Valgimigli M.
- Bueno H.
- Byrne R.A.
- et al.
2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS.
Eur Heart J. 2018; 39: 213-260
]. Yet, there is mounting evidence suggesting that prolonging DAPT is unavoidably associated with higher risks of major bleeding which carry similar or even worse impact on mortality than a recurrent myocardial infarction (MI) [
- Collet J.-.P.
- Thiele H.
- Barbato E.
- et al.
2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.
Eur Heart J. 2021; 42: 1289-1367
- Valgimigli M.
- Landi A.
Ischemic and bleeding risk in patients with acute coronary syndrome undergoing complex percutaneous coronary intervention: is it time to REACT?.
Eur Heart J Acute Cardiovasc Care. 2021; 10: 1125-1128
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- Tailoring oral antiplatelet therapy in acute coronary syndromes: from guidelines to clinical practice.J Cardiovasc Med. 2023; 24
- Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study.Lancet. 2001; 358: 527-533
- 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS.Eur Heart J. 2018; 39: 213-260
- 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.Eur Heart J. 2021; 42: 1289-1367
- Ischemic and bleeding risk in patients with acute coronary syndrome undergoing complex percutaneous coronary intervention: is it time to REACT?.Eur Heart J Acute Cardiovasc Care. 2021; 10: 1125-1128
- Large-Bore Radial Access for Complex PCI.JACC Cardiovasc Interv. 2021; 14: 1304-1307
- Radial versus femoral access in ACS patients undergoing complex PCI is associated with consistent bleeding benefit and no excess of risks.Can J Cardiol. 2022; 38: 1488-1500
- De-escalation of antiplatelet therapy in patients with coronary artery disease: time to change our strategy?.Eur J Intern Med. 2023; 110: 1-9https://doi.org/10.1016/j.ejim.2022.12.008
- Prospective Evaluation of On-Clopidogrel Platelet Reactivity Over Time in Patients Treated With Percutaneous Coronary Intervention: relationship With Gene Polymorphisms and Clinical Outcome.J Am Coll Cardiol. 2011; 57: 2474-2483
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- Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After PCI: an Individual Patient-Level Meta-Analysis.JACC Cardiovasc Interv. 2021; 14: 444-456
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- Comparison of Clopidogrel Monotherapy After 1 to 2 Months of Dual Antiplatelet Therapy With 12 Months of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome: the STOPDAPT-2 ACS Randomized Clinical Trial.JAMA Cardiol. 2022; 7: 407-417
- Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk.N Engl J Med. 2021; 385: 1643-1655
- Duration of antiplatelet therapy after complex percutaneous coronary intervention in patients at high bleeding risk: a MASTER DAPT trial sub-analysis.Eur Heart J. 2022; 43: 3100-3114
- Short Duration of DAPT Versus De-Escalation After Percutaneous Coronary Intervention for Acute Coronary Syndromes.JACC Cardiovasc Interv. 2022; 15: 268-277
Published online: February 19, 2023
Accepted: February 8, 2023
Received: February 3, 2023
© 2023 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.