Recommendation 3. We recommend 6 months (and up to 1 year) of DAPT with ASA and clopidogrel (Strong Recommendation; Moderate-Quality Evidence).
Recommendation 4. We suggest that in patients who have additional high-risk clinical or angiographic features for thrombotic CV events and who are at low risk of bleeding, it is reasonable to extend the duration of DAPT to >1 year (Weak Recommendation; Moderate-Quality Evidence for up to 3 years of treatment).
Recommendation 5. We suggest that in patients who are at high risk of bleeding, the duration of DAPT be shortened to a minimum of 1 month (if a bare-metal stent [BMS] is used) or 3 months (if a DES is used) (Weak Recommendation; Low-Quality Evidence).
Values and preferences. These recommendations place greater emphasis on reduction of major CV thrombotic events and stent thrombosis vs an increase in bleeding complications. These recommendations presume that patients who experience a clinically significant bleed or at high risk of bleeding would be reassessed for the appropriateness of continuation of DAPT at 1 year.
Practical tip. A general principle to consider when deciding on the duration of DAPT is a balanced assessment of the risk of thrombotic CV events and bleeding. Patients at lower risk of thrombotic events and higher risk of bleeding can be considered for a shorter duration of DAPT whereas patients at higher risk of thrombotic events and lower risk of bleeding should be considered for a longer duration of DAPT.
Practical tip. As in the ACS setting, patients who undergo PCI for a non-ACS indication might derive greater absolute benefit of extended DAPT if they have clinical or angiographic features associated with increased risk of thrombotic CV events (Table 1).