Do we still need more data to adopt a short duration of DAPT routinely following PCI in high bleeding risk patients?

As post-percutaneous coronary intervention (PCI) bleeding is increasingly recognised as a prognostically meaningful event1, antiplatelet strategies that minimise bleeding risks while preventing recurrent ischaemic events have been extensively studied in large-scale randomised controlled trials2. The totality of the evidence from these studies, which generally excluded patients at high bleeding risk (HBR), shows that short dual antiplatelet therapy (DAPT) durations (1-3 months) after PCI reduce bleeding and are safe in terms of recurrent ischaemic events, even after a myocardial infarction34. In the vulnerable population of HBR patients, which is in theory the most likely to benefit from DAPT de-escalation, only recently have clinical practice guidelines incorporated recommendations to reduce DAPT duration56. The HBR-specific guideline recommendations were mainly based on the MASTER DAPT trial, which showed that an abbreviated one-month DAPT duration strategy after PCI decreased the risk of major or clinically relevant non-major bleeding, and was non-inferior in terms of net adverse clinical events (NACE) and major adverse cardiac or cerebral events (MACCE), compared with at least two additional months of DAPT in patients at...