Alejandro González Veliz: Not Every Acs Patient Needs 12 Months of Dapt
Alejandro González Veliz, Interventional Cardiologist at Institute of Cardiology and Cardiovascular Surgery, shared a post on LinkedIn:
“Not Every Acs Patient Needs 12 Months of Dapt.
For years, the standard approach after ACS treated with PCI was simple:
Aspirin plus a potent P2Y12 inhibitor
For 12 months
But cardiology is evolving.
The new ESC Clinical Consensus reminds us that antiplatelet therapy should not be a ‘one-size-fits-all’ strategy anymore.
The real challenge is balancing:
- Ischemic risk
- Bleeding risk
And surprisingly…
Bleeding risk is often More common than high ischemic risk.
Why is this important?
Because major bleeding is not a minor complication.
It is associated with:
- Higher mortality
- More hospitalizations
- Treatment discontinuation
- Worse long-term outcomes
Meanwhile, with modern drug-eluting stents:
- Stent thrombosis is uncommon
- Most ischemic events occur early
- Risk decreases substantially after the first months
This has opened the door to new strategies:
- Shorter DAPT duration
- P2Y12 inhibitor monotherapy
- DAPT de-escalation
- Extended therapy only for selected high ischemic-risk patients
But shorter is not always better.
The message of this consensus is clear:
- Assess the patient.
- Identify bleeding risk.
- Identify ischemic risk.
- Individualize treatment.
Because the best antiplatelet strategy is not necessarily the most aggressive…
It’s the one that provides the best balance between efficacy and safety.
Key take-home messages:
- Standard DAPT remains the default strategy.
- Bleeding risk is more prevalent than ischemic risk.
- Short DAPT followed by monotherapy is effective in selected patients.
- Ticagrelor monotherapy is among the strongest alternatives after abbreviated DAPT.
- Antiplatelet therapy after ACS should be personalized, not standardized.
- Treat the patient. Not the protocol.
EuroIntervention 2026
DOI: 10.4244/EIJ-E-26-00003.
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