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DAPT to SAPT Transition — EECC MCQ

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ModerateCoronary Artery DiseaseDAPT to SAPT TransitionEECC

A 65-year-old man with a DES implanted 14 months ago asks whether he still needs aspirin. He has been on aspirin 75 mg and clopidogrel 75 mg since PCI. He has no high ischaemic risk features. What is the current recommendation?

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Correct answer: A — After 6-12 months of DAPT, stepping down to single antiplatelet therapy (either aspirin or clopidogrel monotherapy) is recommended for most patients to reduce bleeding risk while maintaining ischaemic protection

DAPT duration after PCI with DES has been refined by multiple trials. The 2024 ESC CCS Guidelines recommend: (1) Standard risk: 6 months DAPT, then single antiplatelet therapy (SAPT — aspirin or clopidogrel monotherapy); (2) High bleeding risk: 1-3 months DAPT, then SAPT (preferably P2Y12 monotherapy); (3) High ischaemic risk: 12 months or longer DAPT may be considered. The concept of P2Y12 monotherapy (dropping aspirin, continuing clopidogrel/ticagrelor) after short DAPT is supported by TWILIGHT, TICO, STOPDAPT-2, and HOST-EXAM trials, showing reduced bleeding without increased ischaemic events. This patient at 14 months with no high-risk features should be stepped down to SAPT.

Reference: ESC (2024): CCS Guidelines