• Long-term dual antiplatelet therapy (DAPT) with aspirin and ticagrelor reduces ischemic events with evidence of CV mortality reduction in those with highest ischemic risk who don’t have conditions associated with high bleeding risk (including anemia and prior hospitalization for bleeding).
• De-escalation to ticagrelor monotherapy at 3 months post-PCI appears to be a good option if long-term ischemic and stent thrombosis risk is low or there is ongoing bleeding/high risk of

bleeding.

• Clopidogrel monotherapy is not advisable early after PCI due to stent thrombosis risk – it may be a long-term alternative to aspirin monotherapy but effects on all-cause mortality are uncertain.
• Oral anticoagulant therapy targets thrombin-induced platelet activation as well as coagulation and so, may substitute for aspirin, particularly when risk of stent thrombosis is not high; early cessation of aspirin post-PCI and use of apixaban/ ticagrelor combination makes pharmacological sense but more evidence is required.
• Guidelines (e.g., ESC Chronic Coronary Syndromes 2019) and algorithms for antithrombotic therapy regimens can support individualized decision-making.