No One-Size-Fits-All: A Tailored Approach to Antithrombotic Therapy after Stent Implantation

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Antiplatelet therapy with aspirin is a cornerstone of secondary prevention in coronary artery disease (CAD), mainly to prevent recurrent ischemic events. Specifically, it is recommended to use aspirin indefinitely in all revascularized patients1,2. This “secondary preventive effect” of antiplatelet therapy is even more important in patients at higher risk such as those with acute coronary syndromes (ACS). In these patients, dual antiplatelet therapy (DAPT) with clopidogrel in addition to aspirin should be given for 9-12 months as evidenced by the percutaneous coronary Intervention (PCI) subgroup of the Clopidogrel in Unstable angina to prevent Recurrent Events trial (PCI-CURE)3. However, in the large Clopidogrel for High Atherotrombotic Risk and Ischemic Stabilization, Management and Avoidance (CHARISMA) trial, DAPT was not superior over aspirin monotherapy4. Thus, there is no firm trial evidence for a possible longer-term benefit of DAPT in CAD, neither in high-risk patients without nor in patients with revascularization.

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