New insights on the optimal duration of antiplatelet therapy after stent implantation
Antiplatelet monotherapy reduced bleeding, but dual therapy provided greater cardiovascular event protection in patients at high ischemic risk who had undergone stent implantation 12 months earlier. These results, from the A-CLOSE trial, were presented in a Hot Line session at ESC Congress 2026 and were published simultaneously in the New England Journal of Medicine.
This study, presented at the ESC Congress 2026 and published in the New England Journal of Medicine, examined the optimal duration of antiplatelet therapy after stent implantation in high-risk patients. The A-CLOSE trial compared 24 months of clopidogrel monotherapy versus extended dual antiplatelet therapy for 12 months after stent implantation.
After 24 months, the two strategies yielded similar rates of major adverse clinical events, including death, heart attack, stent blocking, stroke, or severe bleeding. However, clopidogrel monotherapy was more effective at reducing clinically relevant bleeding, while extended DAPT provided better protection against key ischemic events.
Professor Byeong-Keuk Kim, the study's principal investigator, concluded that there is no one-size-fits-all approach for long-term antiplatelet therapy. Instead, individualized treatment should be determined based on each patient's ischemic and bleeding risks, clinical characteristics, and personal preferences, through shared decision-making between patients and healthcare providers.
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