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In this systematic review (80 studies; &gt;330,000 patients), we compare personalized versus fixed DAPT strategies, evaluate abbreviated DAPT in high\u2010bleeding\u2010risk (HBR) populations, and evaluate bleeding and ischemic risk scores. Personalized strategies, including genotype\u2010guided therapy, ultra\u2010short DAPT (\u22641 month) with P2Y12 monotherapy, and 3\u2010month DAPT, substantially reduce bleeding (often by roughly 25%\u221265%); ischemic risk after de\u2010escalation is heterogeneous across populations and strategies, with most trials showing neutrality and one (STOPDAPT\u20102 ACS) signaling increased myocardial infarction (MI) when aspirin was withdrawn after 1\u20132 months of clopidogrel\u2010based DAPT in acute coronary syndrome (ACS). In HBR patients, 1 to 3\u2010month DAPT followed by P2Y12 monotherapy lowers major bleeding by up to 65% and may reduce cardiovascular mortality, without increased MI or stent thrombosis in most trials, although ischemic signals varied by population and strategy. In atrial fibrillation, avoiding prolonged triple therapy reduces bleeding by approximately 30%. In ACS, prasugrel is favored over ticagrelor for ischemic outcomes; ARC\u2010HBR, PRECISE\u2010DAPT, and the newer PRECISE\u2010HBR scores show moderate discrimination (c\u2010statistic 0.64\u20130.75). Contemporary data therefore support replacing one\u2010size\u2010fits\u2010all 12\u2010month DAPT with risk\u2010guided algorithms for post\u2010PCI antithrombotic therapy.<\/jats:p>","DOI":"10.1002\/ccd.70733","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T04:43:25Z","timestamp":1783399405000},"page":"946-965","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Personalized Antithrombotic Therapy After Percutaneous Coronary Intervention: A Systematic Review of Risk\u2010Stratified Approaches"],"prefix":"10.1002","volume":"108","author":[{"given":"Thierry","family":"Kochkarian","sequence":"first","affiliation":[{"name":"School of Medicine University of Texas Medical Branch Galveston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anis","family":"Ismail","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Texas 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