Table 2. Duration of dual antiplatelet therapy: comparison between European Society of Cardiology (ESC) guidelines [2017] and American college of cardiology/American Heart Association (ACC/AHA) guidelines [2016].
| ESC guidelines | ACC/AHA guidelines | |
|---|---|---|
| DAPT after PCI (SCAD) | ||
| BMS use | 6 mo.* (IA) | At least 1 mo. (IA) |
| If HBR 3 mo. (IIaB) | ||
| If HBR 1 mo. (IIbC) | ||
| DES use | 6 mo. (IA) | At least 6 mo. (IB) |
| If HBR 3 mo. (IIaB) | If HBR 3 mo. (IIbC) | |
| If HBR 1 mo. (IIbC) | ||
| BVS use | At least 12 mo. (IIaC) | – |
| DCB use | 6 mo. (IIaB) | – |
| DAPT after PCI (ACS) | ||
| BMS use | 12 mo.* (IA) | At least 12 mo. (IB) |
| If not-HBR >12 mo. (IIbA) | If not-HBR >12 mo. (IIbA) | |
| If HBR 6 mo. (IIaB) | If HBR 6 mo. (IIbC) | |
| DES use | At least 12 mo. (IA) | At least 12 mo. (IB) |
| If not-HBR >12 mo. (IIbA) | If not-HBR >12 mo. (IIbA) | |
| If HBR 6 mo. (IIaB) | If HBR 6 mo. (IIbC) | |
| BVS use | At least 12 mo. (IIaC) | – |
| DAPT after CABG (SCAD) | No indication | 12 mo. (IIbB) |
| DAPT after CABG (ACS) | 12 mo. (IC) | 12 mo. (IC) |
| If not-HBR** >12 mo. (IIbC) | ||
| If HBR 6 mo. (IIaC) | ||
| DAPT after medically managed ACS | 12 mo. (IA) | At least 12 mo. (IB) |
| If not-HBR >12 mo.*** (IIbB) | If not-HBR >12 mo. (IIbA) | |
| If HBR at least 1 mo. (IIaC) | ||
| DAPT in patients with an indication to OAC | 1 mo. (IIaB) | – |
| If HTR**** up to 6 mo. (IIaB) |
*, drug eluting stent is the preferred treatment option irrespective of intended DAPT duration; **, if at high ischaemic risk with prior myocardial infarction and CABG, who have tolerated DAPT without a bleeding complication; ***, patients with prior MI at high ischaemic risk who are managed with medical therapy alone and have tolerated DAPT without a bleeding complication, treatment with DAPT in the form of ticagrelor 60 mg b.i.d. on top of aspirin for longer than 12 months and up to 36 months may be considered. In Patients who are not eligible for treatment with ticagrelor, continuation of clopidogrel on top of aspirin for longer than 12 months may be considered (IIbC); ****, patients with high ischaemic risk due to ACS or other anatomical/procedural characteristics that outweigh the bleeding risk. ACS, acute coronary syndrome; BVS, bioresorbable vascular scaffold; BMS, bare metal stent; CABG, coronary artery bypass graft; DAPT, Dual antiplatelet therapy; DEB, drug eluting balloon; DES, drug eluting stent; HBR: high bleeding risk; HTR, high thrombotic risk; OAC, oral anticoagulant; SCAD, stable coronary artery disease.