Abstract
We have sufficient evidence that acute coronary syndrome is caused by atherothrombosis. We also know that coronary stenting leads to further atherosclerotic plaque disruption, triggering thrombosis.
Data from large registries have confirmed that the risk of recurrent myocardial infarction persists in the long term. Results of multiple trials have shown that DAPT reduces this risk.
However, bleeding with DAPT affects adherence and is often the reason for interruption or cessation of treatment. Therefore, patients with acute coronary syndrome face an elevated risk of bleeding while on DAPT and a high risk of recurrent ischaemic events after early cessation of treatment; both risks negatively influence prognosis and cost of care.
Finding a balance between efficacy (modified by intensity and duration of treatment) and safety is an ongoing challenge with DAPT.