Antiplatelet therapy after drug-eluting stent implantation

Dual antiplatelet therapy (DAPT), which is the combination of aspirin and a platelet P2Y12 inhibitor, is the cornerstone of secondary prevention in ischemic heart disease requiring intracoronary stenting. Although the efficacy of DAPT in the reduction of ischemic events has been well validated, the optimal duration, and indeed combination, of therapy is yet to be established. This area continues to attract debate with new developments in stent design and antiplatelet agents, as well as evolving clinical skill levels. Presently, clinical guidelines advocate the use of DAPT for 6-12 months following drug-eluting stent (DES) implantation, but this can vary according to clinical indication, bleeding risk, and country of practice. Concerns have arisen that unnecessary prolongation of DAPT may be associated with increased bleeding events, as well as cost. Whether these guidelines effectively cater to current stenting techniques, devices, and antiplatelet agents remains to be determined. This review analyzes contemporary issues surrounding DAPT following DES implantation, as researchers continue to seek to strike the optimal balance between bleeding and thrombotic risk. Although reduced DAPT durations continue to show promising results in preventing ischemic events while also mitigating bleeding risk, ultimately the consideration of clinical presentation as well as medical and social history is paramount to guiding the optimal duration and cessation of DAPT.