A three-month course of dual antiplatelet therapy (DAPT) after an acute myocardial infarction (MI) appears to come with a better rate of survival and a lower risk of bleeding than the standard 12 months of DAPT, data presented at the 2025 European Society of Cardiology (ESC) congress (29 August–1 September, Madrid, Spain) have shown.
The data—which are consistent with prior meta-analyses showing similar signals—should prompt a reconsideration of guidelines recommending 12 months of DAPT among this patient population, the trial’s lead investigator, David Newby (University of Edinburgh, Edinburgh, UK) has said.
Newby presented the results of DUAL-ACS, an open-label, investigator-initiated, randomised trial, which compared outcomes of both DAPT regimens amongst acute MI patients at centres in Scotland, England and New Zealand, during an ESC hot line trial session on day three of the 2025 congress.
Initially intended to recruit more than 17,000 patients, enrolment was cut short due to the COVID-19 pandemic, he explained, which only allowed the investigators to randomise 5,052 patients among the two study groups. Patients had a mean age of 63 years and 27% were female. Following the index admission, 23% received medical management only, 70% underwent percutaneous coronary intervention (PCI) and 6% had coronary artery bypass graft (CABG) surgery.
Results of the trial after follow-up of 15 months showed that the primary endpoint of all-cause mortality occurred in 2.7% of patients in the three-month DAPT group and 3.4% of patients in the 12-month DAPT group, with a hazard ratio (HR) of 0.78, with no difference in cardiovascular death or non-fatal MI (HR 1.04). Fatal and non-fatal major bleeding occurred in 3.2% of patients in the three-month DAPT group and 4% of patients in the 12-month DAPT group (HR 0.78).
“In the absence of demonstrable benefit, and certain signals of harm that are consistent with prior data, really we should be giving patients three months of antiplatelet therapy after a heart attack and not 12 months,” said Newby.
“For patients, I am sure they would want to take the tablets for the least time possible, but also given that there is no benefit to extending that treatment, and there are real signals of harm, we really do need to be pulling back on this.”
“I would suggest to you that less is more, and that we should now reconsider what the guidelines say,” Newby summarised.
