ESC® 2025 – DUAL-ACS: Is Three Months of DAPT the New Sweet Spot?
Dr. Pedro Barros discusses the DUAL-ACS study, which suggests shortening dual antiplatelet therapy after acute coronary syndrome.
Medical Affairs
2min
8 set, 2025
At ESC® 2025, the results of DUAL-ACS were presented. This pragmatic study evaluated the duration of dual antiplatelet therapy (DAPT) after acute coronary syndrome. Traditionally, the 12-month recommendation is based on historical evidence like the CURE trial, although the greatest benefits of clopidogrel were seen in the first three months. This observation has been reinforced by recent meta-analyses, including a JAMA publication co-authored by Professor Renato Lopes, which identified the 1-to-3-month period as the likely balance point between efficacy and safety.
DUAL-ACS included just over 5,000 patients, but recruitment was halted due to a lack of funding, preventing it from reaching the sample size needed for a definitive answer. Still, the results suggest that three months of DAPT may be sufficient for most patients, with reductions in bleeding events without a significant loss of protection against atherothrombotic events.
The author of the study acknowledged that the analysis is not conclusive but is consistent with the idea of shortening DAPT, especially considering that current regimens tend to maintain the P2Y12 inhibitor and discontinue aspirin, not the other way around. Thus, the study reinforces an ongoing trend in which 12 months of DAPT may no longer be the standard.
As Dr. Pedro Barros pointed out, the "sweet spot" is likely between one and three months. The focus now shifts to the results of the upcoming NeoMindset study, which could provide an even greater challenge to the current standard by exploring the possibility of reducing DAPT to just one month. Until then, clinical practice should consider all available evidence to individualize treatment decisions.
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References:
1) Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK; Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345(7):494-502. doi:10.1056/NEJMoa010746.
2) Vranckx P, Valgimigli M, Lopes RD, et al. Short-Term Dual Antiplatelet Therapy After Drug-Eluting Stenting in Patients With Acute Coronary Syndromes: A Systematic Review and Network Meta-Analysis. JAMA Cardiol. 2024;9(12):1202-1214. doi:10.1001/jamacardio.2024.4085.
3) Newby, D. et al. European Society of Cardiology. Trial findings support 3 months of blood thinners rather than 12 months in patients after a heart attack. Press Release. 30 Aug 2025. Available at: https://www.escardio.org/The-ESC/Press-Office/Press-releases/Trial-findings-support-3-months-of-blood-thinners-rather-than-12-months-in-patients-after-a-heart-attack.
