A significant study presented at the ESC Congress 2025 suggests that a shorter, three-month course of dual antiplatelet therapy (DAPT) may offer improved survival and reduced bleeding risk compared to the standard 12-month regimen for patients recovering from a heart attack. The findings, derived from the DUAL-ACS trial, provide new insights into optimizing treatment for myocardial infarction (MI) patients, potentially reshaping clinical practice.
The DUAL-ACS trial, an open-label, investigator-initiated study, was conducted across Scotland, England, and New Zealand. It included over 5,000 patients with a recent heart attack, treated with either stents, coronary artery bypass grafting, or medical therapy alone. Patients were randomly assigned to receive either three or 12 months of DAPT, which combines aspirin with a P2Y12 inhibitor to prevent blood clots. The study aimed to assess whether a shorter DAPT duration could maintain efficacy while reducing complications, particularly bleeding, which is a known risk of prolonged therapy.
Results showed that all-cause mortality was slightly lower in the three-month DAPT group (2.7%) compared to the 12-month group (3.4%), though the difference was not statistically significant. Similarly, major bleeding events were less frequent in the shorter DAPT group (3.2%) compared to the longer regimen (4.0%), again without reaching statistical significance. No differences were observed in cardiovascular death or non-fatal heart attacks between the groups.
The trial faced challenges, including lower-than-expected recruitment due to the COVID-19 pandemic, which limited its ability to definitively confirm the benefits of shorter DAPT. However, the observed trends align with previous research indicating that shorter DAPT durations may reduce bleeding risks without compromising protection against recurrent heart events.
These findings are particularly relevant for real-world clinical settings, as the study included a diverse patient population reflecting typical heart attack cases. The results suggest that a three-month DAPT regimen could be a safer option for many patients, potentially reducing the burden of prolonged therapy while maintaining effectiveness.
Researchers emphasized the need for further studies to confirm these trends and refine guidelines for DAPT duration. The findings challenge the current standard of 12 months of DAPT, prompting discussions about tailoring treatment to individual patient needs, particularly in the critical first three months after a heart attack when the risk of recurrent events is highest.
The international cardiology community has noted the study’s implications, highlighting its contribution to the ongoing debate over optimal DAPT duration. As further research builds on these findings, the three-month DAPT approach could become a viable option for improving patient outcomes in heart attack recovery.
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