Drug-eluting stents (DES) reduce restenosis, but carry a small risk of late stent thrombosis. Dual antiplatelet therapy is the treatment of choice after DES implantation. Early discontinuation of this therapy, eg, in patients in need of noncardiac surgery, is an important risk factor for stent thrombosis with a high risk of death or myocardial infarction. Therefore, such surgery should be delayed for up to 12 months. If it cannot be, one has to balance risks and benefits of continued antiplatelet therapy. Generally, the risk of stopping dual antiplatelet therapy in the perioperative period appears higher than to perform surgery on continued therapy, except for brain surgery. We discuss evidence-based data that go into this risk-benefit analysis and how to manage these situations practically...