Table 5.

Indication to antiplatelet therapy after stenting in European and American guidelines

ESC GL 2014	ESC GL 2010	American societies’ GL
No-ACS patient • New DES → 6 months • BMS → at least 1 month ACS patient • New DES → up to 12 months • BMS → up to 12 months	No-ACS patient • DES → 6 to 12 months • BMS → at least 1 month ACS patient • DES → 12 months • BMS → 12 months	No-ACS patient • DES → at least 12 months • BMS → at least 1 month ACS patient • DES → at least 12 months • BMS → at least 12 months
Special considerations - Shorter DAPT (<6 months) may be considered in patients with high bleeding risk. - DAPT may be used for more than 6 months in patients at high ischemic risk and low bleeding risk. - In patients with SCAD and atrial fibrillation with indication to anticoagulation and low bleeding risk, triple therapy should be considered for at least 1 month, irrespective of the stent used, followed by dual therapy with (N)OAC + ASA or clopidogrel up to 12 months. In patients with ACS and atrial fibrillation with indication to anticoagulation and low bleeding risk, triple therapy should be considered for at 6 months, irrespective of the stent used, followed by dual therapy with (N)OAC + ASA or clopidogrel up to 12 months. In case of high bleeding risk, triple therapy should be considered for 1 month, irrespective the clinical presentation and the type of stent used, followed by dual therapy with (N)OAC + ASA or clopidogrel.	Special considerations - In patients with a compelling indication for long-term anticoagulation, BMS implantation or stand-alone balloon angioplasty or CABG should be preferred over DES to restrict the duration of triple therapy to 1 month. - Triple therapy should be prescribed for the shortest necessary duration.	Special considerations - In patients receiving BMS for a non-ACS indication, at increased risk of bleeding; clopidogrel (should be given for a minimum of 2 weeks). - If the risk of morbidity from bleeding outweighs the anticipated benefit afforded by a recommended duration of P2Y12 inhibitor therapy after stent implantation, earlier discontinuation (e.g., <12 months) of P2Y12 inhibitor therapy is reasonable. - Continuation of clopidogrel, prasugrel, or ticagrelor beyond 12 months may be considered in patients undergoing placement of DES.