The Evolving Post-PCI Antithrombotic Therapies

This editorial explores evolving strategies for post–percutaneous coronary intervention (PCI) antithrombotic therapy, especially in patients with high bleeding risk. It highlights the Valgimigli et al. trial, which compared abbreviated (30 days) versus standard (6 months) dual antiplatelet therapy (DAPT) among 4579 patients, showing noninferior net clinical outcomes and 30% lower bleeding rates with abbreviated therapy. The author discusses the implications of newer-generation drug-eluting stents with reduced thrombotic risk, as well as trade-offs in noninferiority trial design. Concerns over ischemic events and subgroup effects (e.g. patients on oral anticoagulation) are addressed. The piece advocates for cautious adoption of shorter DAPT durations tailored to individual bleeding and ischemic risks, acknowledging ongoing debates over trial thresholds and generalizability across stent types.

This editorial explores evolving strategies for post–percutaneous coronary intervention (PCI) antithrombotic therapy, especially in patients with high bleeding risk. It highlights the Valgimigli et al. trial, which compared abbreviated (30 days) versus standard (6 months) dual antiplatelet therapy (DAPT) among 4579 patients, showing noninferior net clinical outcomes and 30% lower bleeding rates with abbreviated therapy. The author discusses the implications of newer-generation drug-eluting stents with reduced thrombotic risk, as well as trade-offs in noninferiority trial design. Concerns over ischemic events and subgroup effects (e.g. patients on oral anticoagulation) are addressed. The piece advocates for cautious adoption of shorter DAPT durations tailored to individual bleeding and ischemic risks, acknowledging ongoing debates over trial thresholds and generalizability across stent types.