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.