Evidence from studies published more than
10 years ago suggested that patients receiving first-generation
drug-eluting stents (DES) needed dual antiplatelet therapy (DAPT) for at
least 12 months. Current evidence from randomised controlled trials
(RCT) reported within the past five years suggests that patients with
stable ischaemic heart disease who receive newer-generation DES need
DAPT for a minimum of three to six months. Patients who undergo stenting
for an acute coronary syndrome benefit from DAPT for at least 12
months, but a Bayesian network meta-analysis confirms that extending
DAPT beyond 12 months confers a trade-off between reduced ischaemic
events and increased bleeding. However, the network meta-analysis finds
no credible increase in all-cause mortality if DAPT is lengthened from
three to six months to 12 months (posterior median odds ratio [OR] 0.98;
95% Bayesian credible interval [BCI]: 0.73-1.43), from 12 months to
18-48 months (OR 0.87; 95% BCI: 0.64-1.17), or from three to six months
to 18-48 months (OR 0.86; 95% BCI: 0.63-1.21). Future investigation
should focus on identifying scoring systems that have excellent
discrimination and calibration. Although predictive models should be
incorporated into systems of care, most decisions about DAPT duration
will be based on clinical judgement and patient preference.