Dual antiplatelet therapy (DAPT) remains a cornerstone of management after percutaneous coronary intervention (PCI) and in acute coronary syndromes (ACS). Current European Society of Cardiology (ESC) guidelines recommend 12 months of DAPT after ACS and six months following PCI for chronic coronary syndrome (1). These recommendations, based on studies conducted during the early era of drug-eluting stents and higher baseline thrombotic risk, have shaped practice for nearly two decades.

The rationale for prolonged DAPT is well established: dual inhibition of platelet aggregation reduces the risk of stent thrombosis and recurrent ischemic events. However, these benefits come at a cost. Major bleeding events, often as life-threatening as ischaemic complications, carry significant morbidity and mortality. Over the past decade, advances in stent design, more precise PCI techniques, greater use of intravascular imaging, and improved secondary prevention strategies, have markedly lowered ischemic risk (2). Consequently, the balance between ischemic and bleeding events has shifted, prompting reconsideration of how long DAPT truly needs to continue.