A patient with NSTEMI is started on ticagrelor 180 mg loading dose plus aspirin. After PCI with drug-eluting stent, which of the following is the correct duration of dual antiplatelet therapy (DAPT) according to current ESC guidelines?
- A 1 month only, then ticagrelor monotherapy
- B Indefinite dual antiplatelet therapy
- C 12 months in most patients, with possible shortening to 6 months in high bleeding risk ✓
- D 6 weeks regardless of stent type
Correct answer: C. 12 months in most patients, with possible shortening to 6 months in high bleeding risk
Explanation
Current ESC 2023 ACS guidelines recommend 12 months of DAPT (aspirin + P2Y12 inhibitor) after ACS-PCI as the standard duration. In patients at high bleeding risk (HBR), de-escalation or shortening to 3–6 months is acceptable. Indefinite DAPT is not recommended. One month of DAPT with ticagrelor monotherapy is an emerging approach in very high HBR only. Six weeks is the minimum for bare metal stents, not drug-eluting stents in ACS.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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