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DAPT Duration in High Bleeding Risk — EECC MCQ

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ModerateCoronary Artery DiseaseDAPT Duration in High Bleeding RiskEECC

A 71-year-old man is 3 months post-NSTEMI with a DES to the RCA. He is on aspirin 75 mg, ticagrelor 90 mg bd, and has a high bleeding risk (HBR) due to prior GI bleeding. According to ESC guidelines, what DAPT duration modification is recommended?

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Correct answer: B — Shorten DAPT to 3 months followed by P2Y12 inhibitor monotherapy

For patients at high bleeding risk (HBR), the 2023 ESC ACS Guidelines recommend shortened DAPT duration of 1-3 months after ACS with PCI, followed by P2Y12 inhibitor monotherapy (dropping aspirin). This is based on trials including TWILIGHT, TICO, STOPDAPT-2 ACS, and T-PASS which demonstrated that early aspirin discontinuation with P2Y12 monotherapy significantly reduces bleeding without increasing ischaemic events. The minimum DAPT duration after DES in HBR patients is 1 month. In very high bleeding risk, even shorter durations may be considered with close clinical surveillance.

Reference: ESC (2023): Guidelines for the Management of Acute Coronary Syndromes