Can DAPT be discontinued at one month after PCI in high bleeding risk patients presenting with ACS?

For patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is required for preventing ischaemic events, and 12 months of DAPT is currently the standard treatment12. However, maintaining DAPT long term may be associated with an increased risk of bleeding, and therefore, the strategy of shortening the duration of DAPT has been investigated3. Attaining optimal protection against ischaemic events while avoiding an increase in bleeding-related harm is crucial, especially in patients with high bleeding risk (HBR)3. The MASTER DAPT trial randomised HBR patients undergoing PCI and compared 1-month DAPT with ≥3-month DAPT4. In accordance with the main trial results, its prespecified, stratified subgroup analysis focusing on patients with an acute or recent myocardial infarction demonstrated that while the risk of cardiovascular events did not differ between the two groups, 1-month DAPT was associated with a reduced risk for Bleeding Academic Research Consortium (BARC) type 2-5 bleeding5. However, only biodegradable-polymer sirolimus-eluting stents were used, and approximately 75% of patients in the 1-month DAPT...