Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention with a drug-eluting stent
| Initial DAPT duration |
| The rigid 1-year recommendation for initial DAPT duration has been revised, and the optimal duration is now defined by balancing risk of bleeding vs avoiding future ischemic events |
| In patients with high bleeding risk or low ischemic risk, or both, shorter durations of DAPT are favored; in those with low bleeding risk or high ischemic risk, or both, longer durations of DAPT are favored |
| Perioperative management of DAPT for noncardiac surgery |
| Consider: Risk of bleeding during surgery while on DAPT Risk of stent thrombosis Consequences of delaying surgery |
| Avoid surgery while patient is on DAPT unless emergent or bleeding risk is minimal |
| Risk of stent thrombosis is highest initially and decreases over time but is never zero. If possible, delay surgery for at least 3 months and ideally for 6 months |
| If DAPT is interrupted, continue aspirin, as it protect against stent thrombosis |
| Consider bridging with intravenous antiplatelet agents if the risk of stent thrombosis is particularly high and surgery cannot be delayed |
| Long-term DAPT (> 12 months) |
| Appraise the risks and benefits for the individual patient |
| Consider in patients at high risk of future ischemic events (eg, patients who have had prior myocardial infarction) and low bleeding risk |