Dual antiplatelet
therapy (
DAPT) with
aspirin and a P2Y12 receptor inhibitor constitutes the standard of care to prevent
major adverse cardiac events in patients who undergo
percutaneous coronary intervention (PCI) with
drug-eluting stents (DES). However, the anti-ischemic benefits of
DAPT are counterbalanced by an increased risk of hemorrhagic complications, which are known to be associated with increased morbidity and mortality. While the efficacy of
DAPT in patients presenting with
acute coronary syndrome (ACS) has been well established, the risk-benefit balance of
DAPT in other subsets of patients remain controversial. As a result, multiple risk scores to inform optimal duration of
DAPT have been developed recently for individuals with various degrees of
coronary artery disease. Areas covered: Authors summarize the current evidence and guideline recommendations on the optimal duration and intensity of
DAPT across the spectrum of
coronary artery disease including those who undergo complex PCI and recapitulated the recently developed risk scores to inform clinical decision on the optimal duration of
DAPT. Expert commentary: Clinical decision-making for upfront duration of
DAPT after PCI with DES should consider the individual
bleeding risk profile, the initial clinical presentation and the complexity of coronary stenting.