The focused update on DAPT duration was drafted in a joint effort of the European Society of Cardiology (ESC) and the European Association of Cardio-Thoracic Surgery (EACTS) task forces. It aimed to provide a novel approach to decision-making about DAPT type and duration, based on a four-layer scheme focusing on treatment individualisation (
fig. 2). This is hierarchically based on the
type of intervention (PCI, coronary artery bypass graft or medical treatment alone without revascularisation), on the
treatment indication (stable coronary artery disease or ACS), on the
type of device used in the case of PCI (drug-eluting stent [DES], bare-metal stent [BMS], bioresorbable vascular scaffold [BVS], drug-eluting balloon [DEB]) and finally on the estimated
bleeding risk. Treatment indication has been widely demonstrated to be one of the major drivers for DAPT duration [
12,
13]. Patients presenting with ACS are at higher ischaemic risk, and remain at higher ischaemic risk for a longer period of time after the index event, hence justifying more potent and prolonged antiplatelet treatment [
13–
15]. Unlike in the past, the choice between a BMS and DES is no longer a driver for differences in treatment duration [
2,
16,
17]. In fact, a DES is recommended as the default treatment strategy, and no specific preference for a BMS is based on anticipated DAPT duration. Novel recommendations have now been provided for BVSs, which are recognised as more thrombogenic devices requiring longer treatment [
18]. Bleeding risk is formally included in the treatment algorithm as the final decision-making point for treatment duration, based on the assumption that patients considered at higher bleeding risk should receive a shorter treatment.