Dual antiplatelet therapy after acute coronary syndrome: a cardiologist-based optimal decision

The 2014 European Society of Cardiology (ESC) guidelines recommend 12 months of dual antiplatelet therapy (DAPT) favouring combination of aspirin and prasugrel or aspirin and ticagrelor over aspirin and clopidogrel after acute coronary syndrome (ACS). The DAPT trial showed that extending DAPT beyond 1 year may benefit the patients who are at a higher risk for stent thrombosis or myocardial infarction, but who are also at relatively a lower risk for bleeding. 4 On the other hand, the ITALIC trial showed non-inferiority of a 6 months versus 24 months DAPT after drug-eluting stent implantation. 5 At the time of making a decision to choose the best antiplatelet regimen for ACS patients, the cardiologist may refer to current guidelines including ischaemic and bleeding risk calculation tools.