ESC TV Today – Your Cardiovascular News Season 3 - Ep.28: Extended interview on dual antiplatelet therapy (DAPT) and shortening its optimal duration
Dec 4, 2025
In this engaging discussion, Steffen Massberg, a leading cardiologist from Ludwig Maximilians University Hospital, dives into dual antiplatelet therapy (DAPT). He highlights how about 40% of patients meet high bleeding risk criteria and discusses the implications for shortening DAPT duration. Massberg reviews evidence from key trials supporting shorter therapies and emphasizes the importance of individualized strategies. He also addresses barriers like physician fears regarding stent thrombosis while advocating for advanced imaging techniques to enhance decision-making in DAPT.
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Identify High Bleeding Risk With Scores
- Use validated bleeding‑risk scores like ARC‑HBR to identify high bleeding risk patients before deciding DAPT duration.
- Consider shortened DAPT for patients meeting high bleeding risk criteria instead of default 6–12 month strategies.
Decide Early, Reassess Frequently
- Make an initial DAPT decision at discharge but revisit and re-evaluate it regularly using new clinical and procedural information.
- Update duration if bleeding occurs early or if PCI results and patient tolerance change.
Potent P2Y12 Inhibitors Enable Shorter DAPT
- Potent P2Y12 inhibitors (ticagrelor, prasugrel) act faster and more reliably than clopidogrel, explaining guideline preference in ACS.
- Using potent inhibitors enables safe shortening of DAPT in multiple trials and reduces bleeding.