Safer Heart Stents: Drug-Eluting Stents and the Duration of Antiplatelet Therapy in the Post-Myocardial Infarction Period

Percutaneous coronary intervention (PCI) has significantly improved the management of ischemic heart disease, particularly with the advent of drug-eluting stents (DES), which have substantially lowered the incidence of stent thrombosis compared to bare-metal stents (BMS). Despite this progress, complications such as stent thrombosis, though less frequent, remain clinically relevant. From a pharmacological perspective, dual antiplatelet therapy (DAPT) plays an essential role in minimizing the risk of stent thrombosis, albeit at the cost of an increased bleeding risk. Over time, the duration of DAPT has been progressively shortened, largely attributable to advancements in DES technology, which offer improved safety and efficacy profiles. This review examines clinical trials, randomized controlled studies, and meta-analyses conducted between 2020 and 2024 to evaluate the effectiveness of short-term DAPT in patients receiving DES, with a particular emphasis on the post-myocardial infarction (MI) setting. Emerging data indicate that shorter DAPT regimens do not elevate the risk of stent thrombosis while markedly reducing bleeding complications, thereby endorsing a more concise treatment approach without compromising safety outcomes. Furthermore, the impact of novel technologies and the increasing adoption of personalized therapeutic strategies are explored, underscoring their importance in optimizing clinical outcomes.