Dual antiplatelet therapy after drug-eluting stent implantation: is it time to slacken the reins?

Drug-eluting stents (DES) were introduced in interventional practice more than 10 years ago and rapidly replaced bare-metal stents (BMS) for treatment of coronary artery disease because of their superior capability to reduce the need for restenosis-driven repeat intervention. Soon, it became obvious that besides optimal stenting technique, dual antiplatelet therapy (DAPT), which means the combination of aspirin and a P2Y12 platelet receptor inhibitor, has to be established for a prolonged time after stent implantation in order to avoid potentially catastrophic stent thrombosis (ST). In the era of first-generation DES, it turned out that premature discontinuation of DAPT, which means 3 months for sirolimus-eluting stents (SES) and 6 months for paclitaxel-eluting stents (PES), is a strong predictor of ST (1,2), and this relationship is more pronounced in patients with acute coronary syndromes receiving DES (3).