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eMediNexus 05 February 2018

Use a personalized-medicine approach based on ischemic vs bleeding risks
DAPT (aspirin plus a P2Y12 inhibitor) reduces the risk of stent thrombosis and/or spontaneous MI in patients following PCI or ACS. The risk of bleeding in patients on DAPT is proportionally related to its duration.
For ACS patients, the default DAPT duration should be 12 months, irrespective of the revascularization strategy (medical therapy, PCI, or CABG surgery). Six months of DAPT should be considered in patients at high bleeding risk (PRECISE-DAPT score ≥25). Therapy longer than 12 months may be considered in ACS patients who have tolerated DAPT without a bleeding complication.
The need for a short DAPT regimen should no longer justify the use of bare-metal stents instead of newer-generation drug-eluting stents.
DAPT duration should be guided by an assessment of the individual patients ischemic vs bleeding risks and not by the stent type.
Irrespective of the type of metallic stent implanted, the duration of DAPT in stable CAD patients treated with PCI should be 1 to 6 months depending on the bleeding risk. A longer DAPT duration may be considered in patients whose ischemic risk is greater than the risk of bleeding.
There are insufficient data to recommend DAPT in stable CAD patients treated with CABG.

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