When someone gets a percutaneous coronary intervention (PCI), which involves the use of stents to open blocked arteries, doctors usually prescribe dual antiplatelet therapy (DAPT). This means taking two medications to prevent blood clots- aspirin and a P2Y₁₂ inhibitor (such as clopidogrel, ticagrelor, or prasugrel). The idea is to reduce the risk of heart attacks and stent clots. Sounds smart, but here’s the twist: recent trials suggest that how much benefit vs. risk you get from that combo highly depends on your individual risk profile.

What New Studies Reveal

Two big, recent trials presented at ESC 2025 are shedding light:

• TARGET-FIRST examined low-risk patients who had undergone “complete revascularization” (i.e., no residual clogged arteries after PCI). In them, stopping aspirin after just 1 month and continuing only the P2Y₁₂ inhibitor did not significantly increase ischemic events. But bleeding dropped by roughly half.
• But then there’s NEO-MINDSET, with a more typical group (older, more comorbidities, etc.). In that trial, stopping aspirin almost immediately didn’t meet the noninferiority margin. Sure, bleeding was less, but there was a modest increase in ischemic events (stroke, MI, etc.) beyond acceptable limits.

Why It Matters for You

These studies tell us:

1. Personal risk stratification matters more than blanket rules. Not everyone benefits from long DAPT; for some, shorter or modified therapy may reduce bleeding without raising clot risks too much.
2. Low-risk patients – those with complete revascularization, fewer comorbidities, and a stable situation, might do well with early de-escalation (i.e., stop aspirin early).
3. High-risk patient – with MI, hypertension, diabetes, prior MI, etc, probably still need the usual longer DAPT combo, because their risk of ischemia may outweigh bleeding risk.
4. Bleeding vs. Ischemic Trade-Off – It’s like walking a tightrope. Every medicine that reduces clot risk increases bleeding risk; so the sweet spot depends on how “bleed-prone” you are (age, kidney function, other meds, etc.).

Practical Takeaway: What to Discuss With Your Cardiologist

If you or someone you care about is on or considering DAPT after PCI:

• Ask what risk category you fall into: low vs high ischemic risk / bleeding risk.
• Check if “complete revascularization” was really achieved. Are there still blockages that weren’t treated?
• Find out which P2Y₁₂ inhibitor is being used (clopidogrel vs ticagrelor vs prasugrel), some are more potent (and riskier) than others.
• Ask whether a plan exists for reassessment: e.g., can you drop aspirin after 1 month, or do you need full DAPT for longer?
• Monitor follow-up closely: any signs of bleeding? Any symptoms of ischemia (new pain, unusual fatigue)?

The Bottom Line

DAPT is a powerful medicine. But “powerful” means it can help or hurt, depending on the patient. The latest evidence suggests moving away from “always DAPT for X months” toward personalized antiplatelet therapy: shorter durations, tailored drug choices, careful risk balancing.

If you’re dealing with PCI recovery, use what these studies teach to have a smart, evidence-based conversation with your doctor, because your ideal DAPT duration might be very different from someone else’s.

REFERENCES:

Dual‐Antiplatelet Therapy After Percutaneous Coronary Intervention: How Short Is Too Short? | Journal of the American Heart Association https://share.google/bLrbOsBmo5YlFlGhj 

New trial evidence on the use of blood thinners after coronary stenting https://share.google/O7vp8BxzJMmJ86q08 

Source: European Society of Cardiology https://share.google/v2znHU7DArK5bOA1X