Long-term dual antiplatelet therapy and concomitant optimal medical therapy following percutaneous coronary intervention

The dual antiplatelet therapy (DAPT) consisting of aspirin and a P2Y12 inhibitor exerts protection against ischemic myocardial recurrences. During last two decades, DAPT has become the mainstay for treating patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI), following the initial demonstration that DAPT was superior to anticoagulant therapy in these patients. Initially, and for many years, DAPT was prescribed for 2 to 6 months after PCI in important trials of stent implantation leading to the approval of early-generation drug-eluting stents (DES) by the US Food and Drug Administration. However, the subsequent increasing safety concerns related to the potential occurrence of late and very late stent thrombosis (ST) after implantation of early-generation DES lead to the recommendation of prolonging DAPT to 12 months by the American guidelines (1).