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