# How long should dual antiplatelet therapy continue after PCI?

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**Summary:** 12 months is the default after ACS, individualised by bleeding and ischaemic risk; 1 month can suffice in high bleeding risk.

After PCI with a drug-eluting stent for acute coronary syndrome, the default is 12 months of dual antiplatelet therapy (DAPT: aspirin plus a P2Y12 inhibitor), with duration individualised to ischaemic and bleeding risk. The 2023 ESC acute coronary syndrome guideline recommends 12 months as the standard but endorses shorter or de-escalated regimens in patients at high bleeding risk [1].

In patients at high bleeding risk, abbreviating DAPT is supported by MASTER DAPT: stopping DAPT at 1 month (continuing single antiplatelet therapy) was non-inferior for net adverse clinical and ischaemic events and reduced major or clinically relevant bleeding compared with continuing DAPT for at least 3 additional months [2].

Conversely, selected patients with high ischaemic and low bleeding risk may benefit from extended DAPT beyond 12 months. Duration should be a shared, risk-stratified decision rather than a fixed rule [1, 2].

## Limitations

- Optimal duration is a risk trade-off (ischaemia vs bleeding), not a single fixed number; recommendations differ for chronic coronary syndrome/elective PCI versus ACS.
- MASTER DAPT specifically addresses high-bleeding-risk patients and may not generalise to lower-risk populations.

## Sources

1. [I / Guideline] 2023 ESC Guidelines for the management of acute coronary syndromes. European Heart Journal (2023). DOI 10.1093/eurheartj/ehad191. https://academic.oup.com/eurheartj/article/44/38/3720/7243210
2. [IV / Randomised trial] Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk (MASTER DAPT). New England Journal of Medicine (2021). PMID 34449185. https://pubmed.ncbi.nlm.nih.gov/34449185/

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