Dual antiplatelet therapy duration after drug-eluting stents: how long?

The implantation of drug-eluting stents (DES) has become a standard treatment for the management of patients with coronary artery disease (1). Millions of patients worldwide undergo coronary stenting each year. The use of dual anti-platelet therapy is critically important for the prevention of coronary stent thrombosis (2). Current clinical guidelines recommend at least 6- to 12-month treatment after DES implantation, but a longer duration of dual antiplatelet therapy (DAPT) may be beneficial. Interestingly, there is a slight but significant difference between the European and American guidelines, the European recommending 6 to 12 months, the American recommending at least 12 months after DES (3,4). Indeed, the recent guidelines of the European Society of Cardiology have suggested that 6-month DAPT is reasonable after second generation DES implantation in patients with stable CAD (3). The question of stopping DAPT is an important everyday problem for many clinicians. In everyday clinical practice, the decision on the optimum duration of DAPT for a given patient has to be determined. Several randomized trials comparing different durations of DAPT have been performed, and several meta-analyses have already been published demonstrating the importance of this topic in cardiology (5-9).