Optimal duration of dual antiplatelet therapy

The introduction of dual antiplatelet therapy [DAPT] has dramatically reduced the incidence of thrombotic events after stent implantation; however, many years later, the optimal duration of this treatment is still the subject of debate, as the risk of late and very late stent thrombosis must be weighed against the incidence of bleeding episodes. Current data suggest that the extension of DAPT beyond 12 months after stent implantation adds-if-adds little benefit, with not inconsiderable risk of bleeding. The 6-month DAPT seems, however, safe after implantation of new generation DES. Exception, perhaps, are diabetic patients, in whom at least 12 months DAPT is associated with reduction of thrombotic complications. A disadvantage, of course, of latest studies is the short follow-up period, which means that, in clinical practice, the assessment of thrombotic and hemorrhagic risk in each individual patient remains extremely important.