Purpose of review: To provide updates regarding the optimal duration of dual antiplatelet therapy (DAPT) in patients with acute coronary syndromes (ACS).
Recent findings: Within the past years, five moderate-sized randomized controlled trials evaluated different DAPT durations after percutaneous coronary intervention. These studies included a significant percentage of ACS patients that varied from 30 to 75% depending on the study. Results suggest that in selected populations prolonging DAPT does not offer additional protection from ischemic events and increases bleeding complications. However, results from a large-scale registry illustrate that DAPT durations beyond 6 months are associated with lower cardiovascular risk. Moreover, a multicenter registry demonstrated that the context underlying DAPT cessation is an additional correlate of outcomes after stent implantation.
Summary: Current guidelines suggest 12 months of DAPT after an initial presentation with ACS. Emerging evidence suggest that in selected populations shorter duration might be acceptable.