Durable Antithrombotic Therapy After Acute Coronary Syndromes: Less Is More

For patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI), clinicians face a conundrum of how to reduce ischemic events with antiplatelet therapy without elevating risk for bleeding from prolonged dual antiplatelet therapy (DAPT). In prior studies, attempts at de-escalating DAPT within the first 6 months were associated with excess risk for ischemic events. Yet indiscriminate long-term use of DAPT will lead to a prohibitive risk for bleeding events.

To address this issue, researchers conducted a multicenter, double-blind, placebo-controlled trial in China among patients with ACS who completed DAPT for 9 to 12 months after PCI and were event-free for at least 6 months. Patients were randomized to clo…