[Short dual antiplatelet therapy: how, when and why]

Area of Science:

• Cardiology
• Pharmacology
• Thrombosis Research

Background:

• Dual antiplatelet therapy (DAPT) is standard after percutaneous coronary intervention (PCI).
• Determining optimal DAPT duration balances preventing ischemic events (like stent thrombosis) against bleeding risk.
• Recent evidence emphasizes managing bleeding risk, particularly in high bleeding risk (HBR) patients.

Purpose of the Study:

• To review strategies for safely reducing DAPT duration in HBR patients.
• To discuss clinical decision-making for tailoring antithrombotic therapy in this population.
• To highlight current recommendations and emerging research in DAPT de-escalation.

Main Methods:

• Review of randomized controlled trials and clinical guidelines.
• Analysis of evidence supporting risk-based DAPT duration.
• Discussion of pharmacological and clinical strategies for bleeding risk mitigation.

Main Results:

• Evidence supports shorter DAPT duration in HBR patients, irrespective of thrombotic risk.
• New guidelines favor direct oral anticoagulants (DOACs) over vitamin K antagonists for eligible patients.
• Strategies include P2Y12 inhibitor de-escalation and exploring aspirin discontinuation.

Conclusions:

• Reducing DAPT duration is a key strategy for HBR patients undergoing PCI.
• Personalized treatment decisions considering bleeding risk are paramount.
• Ongoing research explores novel approaches to optimize antithrombotic therapy duration and safety.