Table 2

Dual antiplatelet therapy (DAPT)

IndicationTherapyDuration of therapyGuideline
Minor non-cardioembolic ischaemic stroke <21 days ago, who did not receive IV alteplaseClopidogrel+ASA21 days, followed by lifelong clopidogrel*.2019 FMS Herseninfarct en hersenbloeding7
(Cerebral infarction and cerebral haemorrhage)
Acute coronary syndrome (NSTEMI, STEMI, iAP)DAPT†
(ASA+P2Y12 inhibitor)
3–36 months†
In general 12 months, followed by lifelong SAPT*.
2017 ESC focused update on dual antiplatelet therapy in coronary artery disease9
PCI in stable CAD settingClopidogrel+ASA1–30 months‡
In general 6 months followed by lifelong SAPT*
2017 ESC focused update on dual antiplatelet therapy in coronary artery disease.9
TAVI (without high bleeding risk)Clopidogrel+ASA3–6 months after, TAVI. Followed by lifelong SAPT*.2017 ESC/EACTS Guidelines for the management of valvular heart disease.10
Below the knee bypass with a prosthetic graftClopidogrel+ASAAt least 1 year. Not clearly indicated in guideline for which period. Followed by SAPT*.2017 ESVS/ESC Guidelines on the diagnosis and treatment of peripheral arterial diseases11,12
Carotid artery stentingClopidogrel+ASAAt least 1 month, optimal duration is not known. In studies/research setting till 6 months. Followed by lifelong SAPT*.2011 Society for vascular surgery Guidelines for management of extracranial carotid diasease.13
Revascularisation percutaneous in patients with lower extremity artery disease
Infra-inguinal stent implementation
Clopidogrel+ASAAt least 1 month, in research setting till 12 months. Followed by lifelong SAPT*.2017 ESVS/ESC Guidelines on the diagnosis and treatment of peripheral arterial diseases11,12
  • *Lifelong indication, unless patients develop an indication for a therapeutic anticoagulation therapy. In these cases, the antithrombotic therapy for patients must be evaluated in terms of whether antiplatelet therapy is still indicated.

  • †Depending on indication and treatment choice (medically managed, PCI or CABG, bleeding risk, PRECISE-DAPT score or DAPT score. (2017 ESC focused update on dual antiplatelet therapy in coronary artery disease).13

  • ‡Depending on bleeding risk (PRECISE-DAPT).

  • ASA, acetylsalicylic acid; CABG, coronary artery bypass grafting; CAD, coronary artery disease; EACTS, European Society of Cardio-Thoracic Surgery; ESC, European Society of Cardiology; ESVS, European Society of Vascular Surgery; FMS, Federation of Medical Specialists; iAP, instable angina pectoris; NSTEMI, non-ST-segment elevation myocardial infarction; PCI, percutaneous coronary intervention; TAVI, transcatheter aortic valve implantation.