What does DAPT (dual antiplatelet therapy) mean, and what are the recommended agents, dosages, and duration after coronary stent placement?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: February 12, 2026 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

What is DAPT (Dual Antiplatelet Therapy)?

DAPT means dual antiplatelet therapy, which is the combination of aspirin plus a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor) used to prevent thrombotic complications after coronary stent placement and in acute coronary syndrome patients. 1, 2

Standard DAPT Regimen Components

Aspirin Dosing

  • Aspirin 75-100 mg daily should be continued indefinitely in all patients receiving DAPT 3, 1, 2
  • The lower dose (81 mg in US, 75-100 mg in Europe) minimizes bleeding risk while maintaining efficacy 1, 2

P2Y12 Inhibitor Selection and Dosing

For Acute Coronary Syndrome (ACS) patients:

  • First-line: Ticagrelor - 180 mg loading dose, then 90 mg twice daily 1, 2
  • Alternative: Prasugrel - 60 mg loading dose, then 10 mg daily (only for P2Y12 inhibitor-naïve patients undergoing PCI, contraindicated if prior stroke/TIA) 1, 2
  • Third-line: Clopidogrel - 600 mg loading dose, then 75 mg daily (reserved for patients with contraindications to ticagrelor/prasugrel or requiring oral anticoagulation) 1, 2

For Stable Coronary Artery Disease (CAD) after PCI:

  • Clopidogrel is the preferred P2Y12 inhibitor - 75 mg daily 3
  • Ticagrelor and prasugrel may be considered but have weaker recommendations (Class IIb) 3

Duration of DAPT After Coronary Stent Placement

Standard Duration

  • 12 months is the default duration for ACS patients regardless of stent type 3, 1, 2
  • 6 months is the default duration for stable CAD patients with drug-eluting stents 3
  • 1 month minimum for bare-metal stents in stable CAD 3

Shortened Duration (3-6 months or less)

Consider shortening DAPT in patients with:

  • High bleeding risk (PRECISE-DAPT score ≥25) 3, 1, 2
  • History of major bleeding or gastrointestinal bleeding 3
  • Need for oral anticoagulation 3
  • Age >75 years, weight <60 kg, or other bleeding risk factors 3

The evidence shows that 3-6 months of DAPT after newer-generation drug-eluting stents results in no significant difference in death, MI, or stent thrombosis compared to 12 months, but reduces major bleeding 3

Extended Duration (>12 months, up to 36 months)

Consider extending DAPT beyond 12 months in patients who:

  • Tolerated DAPT without bleeding complications during the initial 12 months 3
  • Have high ischemic risk (prior MI, diabetes, multivessel disease) 3
  • Have low bleeding risk 3

Extended DAPT (18-48 months vs 6-12 months) reduces MI (OR 0.67) and stent thrombosis (OR 0.45) but increases major bleeding (OR 1.58) with no mortality benefit (OR 1.14) 3

Critical Bleeding Risk Mitigation Strategies

Every patient on DAPT should receive:

  • Proton pump inhibitor (PPI) to reduce gastrointestinal bleeding risk 3, 1, 2
  • Radial artery access (not femoral) for coronary procedures when performed by experienced operators 1, 2
  • Low-dose aspirin (75-100 mg daily, not higher doses) 1, 2

Perioperative Management

Timing of Elective Non-Cardiac Surgery

  • Delay surgery at least 1 month after any stent placement (minimum mandatory period) 3
  • Delay surgery 6 months after drug-eluting stent in stable CAD patients 3
  • Delay surgery 12 months after ACS with stent placement for optimal safety 3

P2Y12 Inhibitor Discontinuation Before Surgery

If surgery cannot be delayed and DAPT must be interrupted:

  • Stop ticagrelor at least 3 days before surgery 3
  • Stop clopidogrel at least 5 days before surgery 3
  • Stop prasugrel at least 7 days before surgery 3
  • Continue aspirin perioperatively whenever bleeding risk allows 3, 1
  • Resume P2Y12 inhibitor as soon as safely possible post-operatively 3, 1

Special Populations

Patients Requiring Oral Anticoagulation (Triple Therapy)

  • Minimize triple therapy duration to 1 month if possible 3
  • Use clopidogrel (not ticagrelor or prasugrel) as the P2Y12 inhibitor component 3, 1
  • Transition to dual therapy (P2Y12 inhibitor + anticoagulant, discontinue aspirin) after 1 month in stable patients 3, 2
  • Prefer NOACs over warfarin due to lower bleeding risk 3

Patients with Prior Stroke/TIA

  • Prasugrel is contraindicated (Class III: Harm) 1, 2
  • Ticagrelor is the preferred potent P2Y12 inhibitor in this population 1

Patients Undergoing CABG

  • Continue aspirin throughout the perioperative period 3
  • Resume P2Y12 inhibitor post-operatively as soon as deemed safe to complete the recommended DAPT duration 3

Common Pitfalls to Avoid

  • Do not use clopidogrel as first-line therapy in ACS patients when ticagrelor or prasugrel are available and not contraindicated 1, 2
  • Do not discontinue DAPT within the first month after stent placement for elective procedures 3, 1
  • Do not omit PPI co-prescription in patients on DAPT 1, 2
  • Do not give prasugrel to patients with prior stroke/TIA 1, 2
  • Do not use higher aspirin doses (>100 mg) when combined with P2Y12 inhibitors 1, 2

References

1
Guideline

Dual Antiplatelet Therapy Regimen for Acute Coronary Syndrome and Coronary Stent Placement

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

Dual Antiplatelet Therapy Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

3
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Related Questions

What are Dual Antiplatelet Therapy (DAPT) medications?
Can a patient be on Dual Antiplatelet Therapy (DAPT) and cilostazol simultaneously?
After how many days can we shift from single antiplatelet therapy (APT) to dual antiplatelet therapy (DAPT) for a patient with a large stroke due to large artery disease?
What is the recommended antiplatelet therapy after 12 months in patients with a history of myocardial infarction (MI)?
What is the recommended antiplatelet therapy for a patient with an acute Cerebrovascular Accident (CVA), comparing Dual Antiplatelet Therapy (DAPT) with single antiplatelet therapy?
When should platelets be transfused in a stable adult, including prophylactic thresholds for bleeding risk, before invasive procedures, during active bleeding, and in special situations such as massive transfusion, disseminated intravascular coagulation, severe liver disease, or when antiplatelet therapy is present?
Which renal function parameter should be used to adjust enoxaparin dosing?
How should I manage a patient with a normal prothrombin time/international normalized ratio (~0.9) and elevated serum calcium (2.9 mmol/L)?
What is the appropriate treatment for scabies involving the penis?
How should I evaluate and manage a patient with severe hypercalcemia (serum calcium 2.9 mmol/L) and a low parathyroid hormone level (0.9 pg/mL)?
What is the appropriate autoimmune work‑up for a periorbital rash to differentiate it from allergic contact dermatitis?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question