It Is Time to End the Dualistic Short Versus Long Duration of Dual Antiplatelet Therapy Debates
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At every national and international cardiology meeting, there is at least 1 obligate dualistic debate on whether duration of dual antiplatelet therapy (DAPT) in all patients treated with coronary stent implantation should be short or long. This binary approach is similarly played out in the literature. Although we recognize the usefulness of different intellectual perspectives, as well as the entertainment value of such debates, we believe that the time for debating has passed. Rather, it is time to acknowledge that some patients may best be treated with a short duration of DAPT, some with a standard duration of DAPT, and some with a longer or prolonged duration of DAPT. We should now direct our energies toward identifying these subgroups. Decisions on DAPT duration for any individual patient must be based not on dogmatic or blind adherence to a study result, meta-analysis, or even guideline recommendation but on a thoughtful and informed ongoing assessment of the benefits and risks of DAPT for that particular patient (Figure), as well as patient preference.
This dualistic short versus long debate ignores the fact that many patients with comparable ischemic and bleeding risk may best be treated by a …