Shortening and De-Escalation of Dual Antiplatelet Therapy After PCI

Purpose of Review Dual antiplatelet therapy (DAPT) for a period of 6 to 12 months constitutes the standard of care after percutaneous coronary intervention. Post-PCI DAPT leads to a decrease in rates of ischemic events at the expense of increased bleeding risk. This review article is aimed at discussing novel therapeutic strategies proposed to mitigate the bleeding risk associated with DAPT. Recent Findings Antiplatelet monotherapy after a short- term DAPT post-PCI has been shown to be a feasible and safe alternative. Recent studies have demonstrated that P2Y12 inhibitor monotherapy is associated with improved outcomes compared to DAPT or aspirin. Similarly, antiplatelet de-escalation to less potent P2Y12 inhibitors after a short period of more potent ones has shown promising data. Recent data from large clinical trials have shifted the traditional paradigm of 6- or 12-month antiplatelet therapy after percutaneous coronary interventions. Antiplatelet regimens of shorter duration and variable intensity, based on individual risk factors, comorbidities and bleeding/ischemic risks, appear to be the next antiplatelet frontier post-PCI.