, Volume 77, Issue 16, pp 1733–1754 | Cite as

Dual Antiplatelet Therapy Duration: Reconciling the Inconsistencies

  • Francesco Costa
  • Stephan Windecker
  • Marco ValgimigliEmail author
Review Article


Dual antiplatelet therapy (DAPT) prevents recurrent ischemic events after an acute coronary syndrome (ACS) as well as stent thrombosis (ST) in patients with prior stent implantation. Nevertheless, these benefits are counterbalanced by a significant bleeding hazard, which is directly related to the treatment duration. Although DAPT has been extensively studied in numerous clinical trials, optimal treatment duration is still debated, mostly because of apparent inconsistencies among studies. Shortened treatment duration of 6 or 3 months was shown to mitigate bleeding risk compared with consensus-grounded 12-month standard duration, without any apparent excess of ischemic events. However, recent trials showed that a >12-month course of treatment reduces ischemic events but increases bleeding compared with 12 months. The inconsistent benefit of a longer DAPT course compared with shorter treatment durations is puzzling, and requires a careful appraisal of between-studies differences. We sought to summarize the existing evidence aiming at reconciling apparent inconsistencies among these studies, as well as thoroughly discuss the possible increased risk of fatal events associated with long-term DAPT. Benefits and risks of prolonging or shortening DAPT duration will be discussed, with a focus on treatment individualization. Finally, we will provide an outlook for possible future directions in the field.


Compliance with ethical standards


No external funds were used in the preparation of this manuscript.

Conflict of interest

Francesco Costa declares no conflicts of interest that might be relevant to the contents of this manuscript. Stephan Windecker reports receiving grants from Abbott, Biotronik, Biosensors, Edwards Lifesciences, Medtronic, and St Jude Medical; personal fees from AstraZeneca and Daiichi Sankyo; and grants and personal fees from Boston Scientific and Sanofi, unrelated to this work. Marco Valgimigli has received research grants from The Medicines Company, Terumo, and AstraZeneca, unrelated to this work.


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Francesco Costa
    • 1
    • 2
  • Stephan Windecker
    • 3
  • Marco Valgimigli
    • 2
    • 3
    Email author
  1. 1.Department of Clinical and Experimental MedicinePoliclinic “G. Martino”, University of MessinaMessinaItaly
  2. 2.Thoraxcenter, Erasmus Medical CenterRotterdamThe Netherlands
  3. 3.Swiss Cardiovascular Center BernBern University HospitalBernSwitzerland

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