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The 2025 European Society of Cardiology (ESC) Congress presented several pivotal Hot-Line trials that challenge established paradigms regarding dual antiplatelet therapy (DAPT) duration, agent selection, and risk-based personalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This national advisory statement synthesizes the clinical value and implications of 11 major antiplatelet trials presented at ESC 2025 and provides evidence-aligned, context-specific recommendations for cardiovascular practice in Egypt.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A structured review of ESC 2025 Hot-Line antiplatelet trials was conducted. Evidence was appraised using a predefined grading framework, and national consensus was achieved through a multi-institutional expert panel using modified Delphi methodology. Recommendations were assigned Class of Recommendation and Level of Evidence according to ESC\/ACC standards.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The trials addressed antiplatelet therapy in six clinical pathways: ACS, primary PCI in STEMI, cardiogenic shock, post-CABG, complex PCI, and chronic coronary syndrome requiring oral anticoagulation. Key findings include: (1) selective use of shortened DAPT in stabilized ACS; (2) a potential role for P2Y12 monotherapy after 1 month in low-risk, fully revascularized MI; (3) lack of benefit from ultra-early aspirin withdrawal; (4) no superiority of twice-daily aspirin in high-risk ACS; (5) twice-daily clopidogrel for 1 month as a possible alternative to ticagrelor in resource-limited STEMI settings; (6) superior platelet inhibition with intravenous cangrelor in cardiogenic shock without proven clinical superiority; (7) emerging evidence supporting shorter DAPT or aspirin monotherapy after CABG; (8) score-guided DAPT duration in complex PCI; and (9) confirmation that aspirin should not be added to oral anticoagulation in stable coronary disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The Egyptian Society of Cardiology supports a more individualized, risk-based approach to antiplatelet therapy, emphasizing ischemic\u2013bleeding balance, stent technology, revascularization completeness, and national resource considerations. Recommendations should be interpreted cautiously given the preliminary nature of some ESC 2025 data.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s43044-026-00769-w","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T11:52:27Z","timestamp":1784634747000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Egyptian Society of Cardiology national advisory statement revisiting antiplatelet therapy: insights from E. S. 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