Abstract
The updated ESC guidelines on dual antiplatelet therapy (DAPT) focus on individualization of therapy. It is recommended to plan DAPT duration depending on the individual ischemic- vs. bleeding risk of the patient. Evaluation of ischemic- and bleeding risk may be done using heart teams and risk scores respectively. It is underlined that the decision regarding DAPT duration is dynamic and should be re-assessed on a regular basis. For the first time, it is recommended to choose duration of DAPT irrespectively of stent type (bare metal- vs. drug eluting stent). DAPT duration form one- up to 36 months may be considered depending on the individual risk of the patient. Therefore the sight on DAPT has changed from a device dependent therapy to a systemic therapy in patients with coronary artery disease. In this context, recommendations regarding patients with acute coronary syndrome with medical treatment alone (including patients with myocardial infarction with non-obstructive coronary arteries) and undergoing aorto-coronary bypass graft surgery were amended. DAPT is recommended in both groups. Duration of DAPT depends on the individual risk as outlined above. In patients with non-ST elevation myocardial infarction, the initiation of P2Y12 inhibition may already be considered at time of diagnosis if an invasive approach is planned. Additionally, new recommendations regarding patients with coronary interventions and indication for permanent oral anticoagulation due to atrial fibrillation were established. In these patients non vitamin K oral anticoagulants (NOAC) may be considered instead of vitamin K antagonists. Again, duration of DAPT plus oral anticoagulation (triple therapy) should be recommended according to the individual ischemic- and bleeding risk of the patient. Triple therapy only during hospital course and single antiplatelet medication plus oral anticoagulation already at hospital discharge may even be considered in patients with high bleeding risk.
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