No one-size-fits-all: A tailored approach to antithrombotic therapy after stent implantation.

Antiplatelet therapy with aspirin is a cornerstone of secondary prevention in coronary artery disease (CAD), mainly to prevent recurrent ischemic events. Specifically, it is recommended to use aspirin indefinitely in all revascularized patients.1,2 This “secondary preventive effect” of antiplatelet therapy is even more important in patients at high risk, such as those with acute coronary syndromes. In these patients, dual antiplatelet therapy (DAPT) with clopidogrel in addition to aspirin should be given for 9–12 months, as evidenced by the Percutaneous Coronary Intervention subgroup of the Clopidogrel in Unstable angina to prevent Recurrent Events trial (PCI-CURE).3 However, in the large Clopidogrel for High Atherotrombotic Risk and Ischemic Stabilization, Management and Avoidance (CHARISMA) trial, DAPT was not superior to aspirin monotherapy.4 Thus, there is no firm trial evidence for a possible longer-term benefit of DAPT in CAD in high-risk patients with or without revascularization.