“Ticking away the moments that make up a dull DAPT course”: Time matters

The standard course of 12-month dual antiplatelet therapy (DAPT) with aspirin plus a potent P2Y12 inhibitor (i.e., prasugrel or ticagrelor) is established to be an effective strategy in reducing thrombotic events after an acute coronary syndrome (ACS) and still represents the default strategy in the latest European Society of Cardiology (ESC) guidelines [ [1] Byrne R.A. Rossello X. Coughlan J.J. Barbato E. Berry C. Chieffo A. et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur. Heart J. 2023; Google Scholar ]. However, compared to single antiplatelet therapy (SAPT) or clopidogrel-based DAPT, this strategy is associated with increased bleeding [ [2] Galli M. Laborante R. Andreotti F. Vergallo R. Montone R.A. Iaconelli A. et al. Bleeding complications in patients undergoing percutaneous coronary intervention. . 2022; 23: 8 Google Scholar ]. Bleeding is a relatively frequent complication associated with poor prognosis after ACS, and can be even more prevalent and severe in patients deemed at high bleeding risk (HBR) [ [2] Galli M. Laborante R. Andreotti F. Vergallo R. Montone R.A. Iaconelli A. et al. Bleeding complications in patients undergoing percutaneous coronary intervention. . 2022; 23: 8 Google Scholar ]. The recent availability of stent platforms associated with very low (~1%) rates of stent thrombosis (ST), and the acknowledging that the majority (~80%) of ST and of other thrombotic events such as myocardial infarction (MI) occur in the first 1–3 months after ACS, has sparked the interest towards modulation of the intensity of platelet inhibition after such period, the so called “de-escalation” strategy [ [3] Angiolillo D.J. Galli M. Collet J.P. Kastrati A. O'Donoghue M.L. Antiplatelet therapy after percutaneous coronary intervention. EuroIntervention. 2022; 17: e1371-e1396 Google Scholar , [4] Lopes R.D. Leonardi S. Wojdyla D.M. Vora A.N. Thomas L. Storey R.F. et al. Stent thrombosis in patients with atrial fibrillation undergoing coronary stenting in the AUGUSTUS trial. Circulation. 2020; 141: 781-783 Google Scholar ]. However, whether the HBR status may significantly influence the temporal trends in ischemic and bleeding event risks after ACS remains poorly explored. Temporal variations in ischemic and bleeding event risks after acute coronary syndrome during dual antiplatelet therapyInternational Journal of CardiologyVol. 392PreviewThis study estimates the temporal risk variations of ischemic and bleeding events during dual antiplatelet therapy (DAPT) among patients stratified according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria, suggesting the optimal period for DAPT after acute coronary syndrome (ACS). Full-Text PDF