{"id":7229,"date":"2025-05-29T11:18:54","date_gmt":"2025-05-29T08:18:54","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=7229"},"modified":"2025-05-29T11:18:54","modified_gmt":"2025-05-29T08:18:54","slug":"is-12-months-of-dual-antiplatelet-therapy-dapt-still-justified","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/is-12-months-of-dual-antiplatelet-therapy-dapt-still-justified\/","title":{"rendered":"Is 12 Months of Dual Antiplatelet Therapy (DAPT) Still Justified?"},"content":{"rendered":"
\ud83d\udd0d Is 12 Months of Dual Antiplatelet Therapy (DAPT) Still Justified?<\/div>\n
Source: theheart.org on Medscape \u2013 May 12, 2025 | Commentary by Dr. Christopher Labos<\/div>\n
<\/div>\n
\ud83e\ude7a Background:<\/div>\n
\u2022 A full year of DAPT after stenting became standard practice following the CURE trial (2001), despite limited evidence on the optimal duration.<\/span><\/div>\n
\u2022 Later trials (TRITON-TIMI 38, PLATO) supported DAPT but did not evaluate a 12-month regimen directly.<\/span><\/div>\n
\u2022 Advances in stents and therapies question the relevance of old data.<\/span><\/div>\n
<\/div>\n
\u2696 Ischemic vs Bleeding Risk:<\/div>\n
\u2022 Longer DAPT (>12 months) may reduce ischemic events but increases bleeding (seen in DAPT trial and meta-analyses).<\/span><\/div>\n
\u2022 Shorter DAPT durations (1\u20136 months) often yield similar outcomes with less bleeding, especially in low-risk patients.<\/span><\/div>\n
<\/div>\n
\ud83e\uddea Key Trials Challenging the 12-Month Norm:<\/div>\n
\u2022 SMART-CHOICE: 3 months DAPT then clopidogrel = safe.<\/span><\/div>\n
\u2022 STOPDAPT-2: 1 month DAPT then clopidogrel = reduced bleeding.<\/span><\/div>\n
\u2022 TWILIGHT: Ticagrelor monotherapy after 3 months = safe in high-risk patients.<\/span><\/div>\n
\u2022 STOPDAPT-3: Aspirin-free strategy with low-dose prasugrel = feasible, but less applicable due to dosing concerns.<\/span><\/div>\n
\u2022 HOST-BR (ACC 2025):<\/span><\/div>\n
\u2022 High bleeding risk: 1 month DAPT = more events.<\/span><\/div>\n
\u2022 Low bleeding risk: 3 months DAPT = less bleeding, no extra ischemic risk.<\/span><\/div>\n
\u2022 SMART-CHOICE 3: After completing 6\u201312 months DAPT, monotherapy with clopidogrel reduced MAACE over 3 years (vs aspirin).<\/span><\/div>\n
<\/div>\n
\ud83c\udf0d Ethnicity and Therapy:<\/div>\n
\u2022 Many trials conducted in East Asia; clopidogrel preferred due to bleeding risk.<\/span><\/div>\n
\u2022 Applicability to other ethnicities (e.g., Western populations) remains uncertain.<\/span><\/div>\n
<\/div>\n
\ud83d\udcd8 Guideline Status (2025 ACS):<\/div>\n
\u2022 Still recommend 12 months DAPT (Class 1A) unless high bleeding risk.<\/span><\/div>\n
\u2022 Allow shorter DAPT followed by:<\/span><\/div>\n
\u2022 Ticagrelor monotherapy after 1 month (Class 1A).<\/span><\/div>\n
\u2022 Switching to clopidogrel (Class 2B).<\/span><\/div>\n
\u2022 Any monotherapy after 1 month (Class 2B).<\/span><\/div>\n
<\/div>\n
\ud83e\udde0 Key Messages:<\/div>\n
\u2022 The 12-month DAPT standard was never directly proven to be superior.<\/span><\/div>\n
\u2022 Modern data supports shorter, personalized DAPT durations.<\/span><\/div>\n
\u2022 Clinical inertia, habit, and fear of stent thrombosis maintain the 12-month mindset.<\/span><\/div>\n
\u2022 Primary care may hesitate to deviate from interventional cardiologist recommendations.<\/span><\/div>\n
https:\/\/click.mail.medscape.com\/?qs=8ed0316a1ac0598ccea0a2ba5d1643c4cadc440634ffaf0f35931c1ead99492436f094cde705acba5dd2b7d3370c813a12d337902f74162f9cb1e8ac67aeb3f5<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"

\ud83d\udd0d Is 12 Months of Dual Antiplatelet Therapy (DAPT) Still Justified? Source: theheart.org on Medscape \u2013 May 12, 2025 | Commentary by Dr. Christopher Labos \ud83e\ude7a Background: \u2022 A full year of DAPT after stenting became standard practice following the CURE trial (2001), despite limited evidence on the optimal duration. \u2022 Later trials (TRITON-TIMI 38, […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-7229","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/7229","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=7229"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/7229\/revisions"}],"predecessor-version":[{"id":7230,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/7229\/revisions\/7230"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=7229"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=7229"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=7229"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}