High bleeding risk population represents a significant proportion of coronary artery disease (CAD) patients undergoing coronary stent implantation. Decisions regarding the duration of dual antiplatelet therapy (DAPT) after stent implantation are difficult, especially after implantation of newer generation drug eluting stents (DES) due to conflicting results from recent trials.
The current ESC guidelines of myocardial revascularization indicate that in patients at high bleeding risk (HBR), shorter DAPT duration (<6 months) might be considered after DES implantation (Class of recommendation: IIb). Similarly, the more recent American guidelines on DAPT duration, stated that in patients treated with DAPT after DES implantation who develop a high risk of bleeding (e.g., treatment with oral anticoagulant therapy), are at high risk of severe bleeding complication (e.g., major intracranial surgery), or develop significant overt bleeding, discontinuation of P2Y12 inhibitor therapy after 3 or 6 months may be reasonable (Class of recommendation IIb). Both the European and American guidelines acknowledge that limited data is
currently available to sustain this practice and call for dedicated DAPT studies in HBR patients.
Therefore, further randomized trials are needed to appraise the optimal DAPT duration in HBR patients treated with contemporary DES.