Dual antiplatelet therapy (DAPT), consisting of aspirin combined with a P2Y12 receptor inhibitor, remains a cornerstone of post-percutaneous coronary intervention (PCI) management following drug-eluting stent (DES) implantation. While prolonged DAPT reduces ischemic complications, it increases bleeding risk. The optimal duration remains a subject of ongoing investigation.

Objective

To review contemporary evidence regarding DAPT duration following DES implantation, evaluate clinical outcomes associated with short-, standard-, and extended-duration DAPT, and discuss individualized treatment strategies.

Methods

A comprehensive review of randomized controlled trials, meta-analyses, international guidelines, and observational studies published between 2010 and 2025 was performed. Clinical outcomes including stent thrombosis, myocardial infarction, bleeding events, and mortality were analyzed.

Results

Advances in second- and third-generation DES technology have enabled shorter DAPT regimens without significantly increasing stent thrombosis risk in selected patients. Short-duration DAPT (1–3 months) is increasingly favored in patients at high bleeding risk, while extended DAPT beyond 12 months may benefit selected high ischemic-risk populations. Individualized treatment guided by ischemic and bleeding risk scores provides the most effective strategy.

Conclusion

Modern DES platforms have transformed antiplatelet management following PCI. Personalized DAPT duration based on patient characteristics, procedural complexity, and risk stratification tools optimizes clinical outcomes while minimizing adverse events.