P2Y12 inhibitors in acute coronary syndrome: when to give them and when to prolong their use.

Introduction Dual antiplatelet treatment (DAPT) entered, in 2016, the 20-year anniversary since the publication of the initial data establishing its superiority over anticoagulation treatment in patients after percutaneous coronary angioplasty (PCI). Since then, there has been important advancement both in interventional cardiology and in pharmacological treatments. New and more powerful P2Y12 receptor inhibitors have been introduced, as well as first and then secondgeneration drug-eluting stents (DES), and more recently bioabsorbable stents, which revolutionized the field of percutaneous revascularization. For many years, the duration of DAPT has not been the subject of scientific debate. Through the years, when late intrastent thrombosis became an issue, attention was then directed on the duration of combined therapy with aspirin and P2Y12 receptor antagonists. In the meantime, the stent technology has rapidly progressed with the introduction of newgeneration DES, characterized by thinner stent struts, lower dose of eluted drugs and more biocompatible polymers, now even biodegradable. Accordingly, the new DES are today standard of therapy, and the duration of DAPT is an important topic of discussion.