2026 ACC Scientific Statement: Antiplatelet therapy enters the era of personalized, risk-guided care.<\/p>\n
Source: JACC, 2026 ACC Scientific Statement (June 30, 2026).<\/p>\n
Treatment should balance ischemic and bleeding risks using clinical assessment and validated tools (DAPT score for ischemic benefit vs bleeding, PRECISE-DAPT and ARC-HBR for bleeding risk).<\/p>\n
\u2022\u2060 \u2060Routine aspirin for primary prevention is no longer recommended in unselected adults; it should be considered only in adults 40\u201370 years at high ASCVD risk and low bleeding risk, and generally avoided after age 70.<\/p>\n
Antiplatelet Therapy After ACS-PCI:<\/p>\n
\u2022\u2060 \u2060Default strategy: 12 months of DAPT remains the standard after ACS-PCI.
\n\u2022\u2060 \u2060P2Y12 inhibitor: Ticagrelor or prasugrel are preferred over clopidogrel, while clopidogrel remains appropriate in many older patients or those at higher bleeding risk.
\n\u2022\u2060 \u2060If bleeding risk is high and ischemic risk is low (e.g., ARC-HBR, elderly\/frail patients, prior bleeding, oral anticoagulation, CKD, or anemia), DAPT may be shortened to 1\u20133 months, followed by ticagrelor or prasugrel monotherapy to reduce bleeding.
\n\u2022\u2060 \u2060If ischemic risk is high (e.g., STEMI with large thrombus burden, LM\/complex PCI , CKD, or prior MI ), the standard 12-month DAPT strategy should generally be maintained.
\n\u2022\u2060 \u2060Patients with both high bleeding and high ischemic risk require individualized treatment, balancing both risks.
\nIn summary:
\nDefault \u2192 12-month DAPT
\nHigh bleeding + no high ischemic risk \u2192 Short DAPT (1\u20133 months) \u2192 P2Y12 monotherapy
\nHigh ischemic risk \u2192 Continue 12-month DAPT
\nBoth high \u2192 Individualized decision<\/p>\n
\u2022\u2060 \u2060Beyond 1 year after MI\/ACS, antiplatelet therapy should be individualized; emerging evidence suggests clopidogrel monotherapy may outperform aspirin for long-term secondary prevention in selected patients.
\n\u2022\u2060 \u2060In patients requiring oral anticoagulation (e.g., AF), prolonged triple therapy should be avoided, favoring early aspirin discontinuation and simplified regimens to reduce bleeding.<\/p>\n