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Antithrombotic therapy after 1 year of dual antiplatelet therapy following acute coronary syndrome: what to do?

Research output: Contribution to journalEditorialpeer-review

Original languageEnglish
JournalInternational Journal of Cardiology
Early online date20 Nov 2021
Accepted/In press16 Nov 2021
E-pub ahead of print20 Nov 2021

King's Authors


The benefits of antithrombotic, and in particular antiplatelet, therapy in patients with atherosclerotic cardiovascular disease are well established, the accumulated evidence now stretching back well over three decades. What has been more difficult to pin down is the optimal intensity as well as duration of such therapy in different clinical situations, since the undoubted benefits (in terms of prevention of thrombotic complications) have to be balanced against the harms (and in particular bleeding complications) that come with it. In primary prevention, the weight of evidence suggests that there is little to be gained by antiplatelet therapy, since the relatively small reduction in thrombotic risk is matched (or even exceeded) by the bleeding risk; whereas by contrast, following acute coronary syndrome, a situation where re-thrombotic risk is high, the benefit gained by one year of dual antiplatelet therapy (DAPT) with aspirin combined with a potent P2Y12 inhibitor greatly outweighs the risk from bleeding (although, in patients considered at especially high bleeding risk, there is reason to reduce the intensity and/or length of DAPT). These considerations are reflected in the most recent international guidelines, including from the European Society of Cardiology [ [1] ] and the American College of Cardiology / American Heart Association [ [2] ].

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