Cardiovascular Research Technologies 2025: Beyond the Guidelines: DAPT selection and duration before and after PCI

Cardiovasc Revasc Med. 2025 Aug:77:1-6. doi: 10.1016/j.carrev.2025.06.035. Epub 2025 Jun 30.

Abstract

Dual antiplatelet therapy (DAPT) remains a cornerstone of secondary prevention in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS). The balance between ischemic protection and bleeding risk has driven refinements in therapy duration. In 2025, the American College of Cardiology (ACC), American Heart Association (AHA), American College of Emergency Physicians (ACEP), National Association of EMS Physicians (NAEMSP), and the Society of Cardiovascular Angiography and Interventions (SCAI) released joint guidelines on the management of patients with ACS, with a particular emphasis on DAPT duration. Considering these recently updated guidelines, the 2025 Cardiovascular Research Technologies (CRT) conference convened a session with leading interventional cardiology experts, entitled "Beyond the Guidelines - DAPT Selection and Duration Before and After PCI" to discuss implementation strategies for DAPT based on unique clinical scenarios and the new guideline recommendations. This article synthesizes the current guideline-directed recommendations and expert discussion to provide an evidence-based perspective on beyond the guidelines topics such as optimal DAPT duration, individualized de-escalation strategies, and evolving treatment paradigms for special populations.

Keywords: ACS; Acute coronary syndrome; DAPT; Dual-antiplatelet therapy; PCI; Percutaneous coronary intervention.

Publication types

  • Review

MeSH terms

  • Acute Coronary Syndrome* / blood
  • Acute Coronary Syndrome* / diagnosis
  • Acute Coronary Syndrome* / diagnostic imaging
  • Acute Coronary Syndrome* / mortality
  • Acute Coronary Syndrome* / therapy
  • Clinical Decision-Making
  • Consensus
  • Drug Administration Schedule
  • Dual Anti-Platelet Therapy* / adverse effects
  • Dual Anti-Platelet Therapy* / standards
  • Evidence-Based Medicine / standards
  • Hemorrhage / chemically induced
  • Humans
  • Patient Selection
  • Percutaneous Coronary Intervention* / adverse effects
  • Percutaneous Coronary Intervention* / standards
  • Platelet Aggregation Inhibitors* / administration & dosage
  • Platelet Aggregation Inhibitors* / adverse effects
  • Practice Guidelines as Topic
  • Risk Assessment
  • Risk Factors
  • Secondary Prevention* / standards
  • Time Factors
  • Treatment Outcome

Substances

  • Platelet Aggregation Inhibitors