{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T04:47:12Z","timestamp":1782276432713,"version":"3.54.5"},"reference-count":97,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor remains the cornerstone of antithrombotic management after myocardial revascularization. However, the traditional \u201cone-size-fits-all\u201d approach to DAPT duration and intensity fails to account for marked interindividual variability in drug response\u2014driven by genetic polymorphisms, notably CYP2C19 variants like CYP2C19*2, which reach a frequency of up to 75% in specific groups like the Melanesian population\u2014comorbidities such as diabetes and chronic kidney disease, and dynamic clinical factors including age and concomitant medications. We examine the current landscape of precision medicine tools for individualizing DAPT, including platelet function testing, point-of-care genotyping, validated clinical risk scores, and emerging artificial intelligence (AI)\u2013based predictive models. Evidence from landmark trials is synthesized to evaluate escalation, de-escalation, and duration-tailoring strategies within the ischemic\u2013bleeding trade-off framework. Special populations requiring individualized approaches are reviewed, including patients with atrial fibrillation, the elderly, and those requiring urgent noncardiac surgery with perioperative bridging. Future directions, including multi-omics integration, novel antiplatelet agents, and AI-driven clinical decision support systems, are also explored. As a narrative review, conclusions should be interpreted as reflective of current evidence synthesis rather than systematic-review-grade evidence, given the absence of formal risk-of-bias scoring or meta-analytic pooling. Personalized DAPT guided by complementary genetic and phenotypic testing, integrated with dynamic risk stratification, offers a paradigm shift from empiric therapy toward precision-guided antithrombotic management with the potential to simultaneously reduce ischemic and bleeding complications.<\/jats:p>","DOI":"10.3390\/jcm15134870","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T03:09:17Z","timestamp":1782270557000},"page":"4870","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Modern Era in Personalized Medicine of Dual Antiplatelet Therapy After Myocardial Revascularization"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1290-6718","authenticated-orcid":false,"given":"Amin","family":"Dehghan","sequence":"first","affiliation":[{"name":"Department of Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3613-0590","authenticated-orcid":false,"given":"Niloufar","family":"Javadi","sequence":"additional","affiliation":[{"name":"Aurora Cardiovascular and Thoracic Services, Aurora Sinai\/Aurora St. Luke\u2019s Medical Centers, Aurora Health Care, Milwaukee, WI 53215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suhail Q.","family":"Allaqaband","sequence":"additional","affiliation":[{"name":"Aurora Cardiovascular and Thoracic Services, Aurora Sinai\/Aurora St. Luke\u2019s Medical Centers, Aurora Health Care, Milwaukee, WI 53215, USA"},{"name":"Department of Cardiovascular Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5072-710X","authenticated-orcid":false,"given":"M. Fuad","family":"Jan","sequence":"additional","affiliation":[{"name":"Aurora Cardiovascular and Thoracic Services, Aurora Sinai\/Aurora St. Luke\u2019s Medical Centers, Aurora Health Care, Milwaukee, WI 53215, USA"},{"name":"Department of Cardiovascular Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.clinthera.2025.12.003","article-title":"Implementing CYP2C19 pharmacogenetic testing for personalized antiplatelet therapy: Findings from the QPGx-CARES Initiative","volume":"48","author":"Mohammed","year":"2026","journal-title":"Clin. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1080\/14796678.2024.2384217","article-title":"Does one size really fit all? The case for personalized antiplatelet therapy in interventional cardiology","volume":"20","author":"Elserwey","year":"2024","journal-title":"Future Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3059","DOI":"10.1093\/eurheartj\/ehad362","article-title":"Personalised antiplatelet therapies for coronary artery disease: What the future holds","volume":"44","author":"Capodanno","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"462","DOI":"10.31083\/j.rcm2512462","article-title":"Progress analysis of personalized antiplatelet therapy in patients with coronary heart disease undergoing interventional therapy","volume":"25","author":"Yang","year":"2024","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e002436","DOI":"10.1136\/openhrt-2023-002436","article-title":"Role of genetic polymorphisms in clopidogrel response variability: A systematic review","volume":"10","author":"Lopez","year":"2023","journal-title":"Open Heart"},{"key":"ref_6","unstructured":"Pratt, V.M., Scott, S.A., Pirmohamed, M., Esquivel, B., Kattman, B.L., and Malheiro, A.J. (2012). Clopidogrel Therapy and CYP2C19 Genotype. Medical Genetics Summaries, National Center for Biotechnology Information (US)."},{"key":"ref_7","first-page":"1723","article-title":"A nearly 50% risk of MACCE cutdown by personalized antiplatelet therapy: The subgroup analysis of hypertension in PATH-PCI Trial","volume":"106","author":"Wu","year":"2025","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.jacc.2021.06.010","article-title":"Factor XI inhibition to uncouple thrombosis from hemostasis: JACC Review Topic of the Week","volume":"78","author":"Hsu","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e123","DOI":"10.1161\/CIR.0000000000000404","article-title":"2016 ACC\/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: A report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines: An update of the 2011 ACCF\/AHA\/SCAI guideline for percutaneous coronary intervention, 2011 ACCF\/AHA guideline for coronary artery bypass graft surgery, 2012 ACC\/AHA\/ACP\/AATS\/PCNA\/SCAI\/STS guideline for the diagnosis and management of patients with stable ischemic heart disease, 2013 ACCF\/AHA guideline for the management of ST-elevation myocardial infarction, 2014 AHA\/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes, and 2014 ACC\/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery","volume":"134","author":"Levine","year":"2016","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Zhang, X., Jiang, S., Xue, J., Ding, Y., Gu, J., Hu, L., Xu, X., Li, Z., Kong, Y., and Li, Y. (2022). Personalized antiplatelet therapy guided by clopidogrel pharmacogenomics in acute ischemic stroke and transient ischemic attack: A prospective, randomized controlled trial. Front. Pharmacol., 13.","DOI":"10.3389\/fphar.2022.931405"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2118","DOI":"10.1001\/jama.2012.54506","article-title":"Association of warfarin therapy duration after bioprosthetic aortic valve replacement with risk of mortality, thromboembolic complications, and bleeding","volume":"308","author":"Andersson","year":"2012","journal-title":"JAMA"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1056\/NEJMoa2017815","article-title":"Aspirin with or without clopidogrel after transcatheter aortic-valve implantation","volume":"383","author":"Brouwer","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Kramer, A., Patti, G., Nielsen-Kudsk, J.E., Berti, S., and Korsholm, K. (2024). Left atrial appendage occlusion and post-procedural antithrombotic management. J. Clin. Med., 13.","DOI":"10.3390\/jcm13030803"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"60","DOI":"10.31083\/j.rcm2502060","article-title":"Antithrombotic therapy following structural heart disease interventions: Current status and future directions","volume":"25","author":"Mitsis","year":"2024","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2639","DOI":"10.1016\/j.jcin.2024.08.027","article-title":"International consensus statement on platelet function and genetic testing in percutaneous coronary intervention: 2024 update","volume":"17","author":"Angiolillo","year":"2024","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3415","DOI":"10.1093\/eurheartj\/ehae177","article-title":"2024 ESC guidelines for the management of chronic coronary syndromes","volume":"45","author":"Vrints","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/S0140-6736(08)61845-0","article-title":"Cytochrome P450 2C19 polymorphism in young patients treated with clopidogrel after myocardial infarction: A cohort study","volume":"373","author":"Collet","year":"2009","journal-title":"Lancet"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Iftikhar, H. (2025). AI-driven personalization of dual antiplatelet therapy duration post-PCI: A novel approach balancing ischemic and bleeding risks. medRxiv.","DOI":"10.1101\/2025.03.16.25324067"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.ijcard.2015.06.016","article-title":"A pharmacodynamic comparison of a personalized strategy for anti-platelet therapy versus ticagrelor in achieving a therapeutic window","volume":"197","author":"Malhotra","year":"2015","journal-title":"Int. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1001\/jama.2015.1671","article-title":"Antiplatelet therapy duration following bare metal or drug-eluting coronary stents: The dual antiplatelet therapy randomized clinical trial","volume":"313","author":"Kereiakes","year":"2015","journal-title":"JAMA"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/S0140-6736(17)30397-5","article-title":"Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: A pooled analysis of individual-patient datasets from clinical trials","volume":"389","author":"Costa","year":"2017","journal-title":"Lancet"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1161\/CIRCULATIONAHA.119.040167","article-title":"Defining high bleeding risk in patients undergoing percutaneous coronary intervention","volume":"140","author":"Urban","year":"2019","journal-title":"Circulation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2224","DOI":"10.1016\/j.jacc.2016.02.064","article-title":"Coronary thrombosis and major bleeding after PCI with drug-eluting stents: Risk scores from PARIS","volume":"67","author":"Baber","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.jcin.2020.01.226","article-title":"Derivation, validation, and prognostic utility of a prediction rule for nonresponse to clopidogrel: The ABCD-GENE score","volume":"13","author":"Angiolillo","year":"2020","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e24214","DOI":"10.1002\/clc.24214","article-title":"Smoking and outcomes following personalized antiplatelet therapy in chronic coronary syndrome patients: A substudy from the randomized PATH-PCI trial","volume":"47","author":"Pan","year":"2024","journal-title":"Clin. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1093\/ehjcvp\/pvz059","article-title":"Personalized antiplatelet therapy guided by a novel detection of platelet aggregation function in stable coronary artery disease patients undergoing percutaneous coronary intervention: A randomized controlled clinical trial","volume":"6","author":"Zheng","year":"2020","journal-title":"Eur. Heart J. Cardiovasc. Pharmacother."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1097\/FPC.0b013e32831ebb30","article-title":"Pharmacogenetic variation at CYP2C9, CYP2C19, and CYP2D6 at global and microgeographic scales","volume":"19","author":"Sistonen","year":"2009","journal-title":"Pharmacogenet Genom."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1056\/NEJMoa0809171","article-title":"Cytochrome p-450 polymorphisms and response to clopidogrel","volume":"360","author":"Mega","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1001\/jama.2011.290","article-title":"Standard- vs high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention: The GRAVITAS randomized trial","volume":"305","author":"Price","year":"2011","journal-title":"JAMA"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1002\/cpt.2526","article-title":"Clinical pharmacogenetics implementation consortium guideline for CYP2C19 genotype and clopidogrel therapy: 2022 update","volume":"112","author":"Lee","year":"2022","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1016\/j.jacc.2024.06.038","article-title":"Genotype-guided antiplatelet therapy: JACC Review Topic of the Week","volume":"84","author":"Ingraham","year":"2024","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e129","DOI":"10.1161\/CIR.0000000000001257","article-title":"CYP2C19 genetic testing for oral P2Y12 inhibitor therapy: A scientific statement from the American Heart Association","volume":"150","author":"Pereira","year":"2024","journal-title":"Circulation"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Le Blanc, J., Mullier, F., Vayne, C., and Lordkipanidz\u00e9, M. (2020). Advances in platelet function testing-light transmission aggregometry and beyond. J. Clin. Med., 9.","DOI":"10.3390\/jcm9082636"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1177\/1076029618772354","article-title":"Point of care tests VerifyNow P2Y12 and INNOVANCE PFA P2Y compared to light transmittance aggregometry after fibrinolysis","volume":"24","author":"Roule","year":"2018","journal-title":"Clin. Appl. Thromb. Hemost."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2206915","DOI":"10.1080\/09537104.2023.2206915","article-title":"Age and outcomes following personalized antiplatelet therapy in chronic coronary syndrome patients: A post hoc analysis of the randomized PATH-PCI trial","volume":"34","author":"Pan","year":"2023","journal-title":"Platelets"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1016\/j.jcin.2019.03.034","article-title":"Updated expert consensus statement on platelet function and genetic testing for guiding P2Y(12) receptor inhibitor treatment in percutaneous coronary intervention","volume":"12","author":"Sibbing","year":"2019","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1762","DOI":"10.1093\/eurheartj\/ehv104","article-title":"Bleeding and stent thrombosis on P2Y12-inhibitors: Collaborative analysis on the role of platelet reactivity for risk stratification after percutaneous coronary intervention","volume":"36","author":"Aradi","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1016\/j.jacc.2010.02.031","article-title":"Impact of cytochrome P450 2C19 loss-of-function polymorphism and of major demographic characteristics on residual platelet function after loading and maintenance treatment with clopidogrel in patients undergoing elective coronary stent placement","volume":"55","author":"Hochholzer","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"546","DOI":"10.4244\/EIJ-E-23-00022","article-title":"DAPT guided by platelet function tests or genotyping after PCI: Pros and cons","volume":"19","author":"Angiolillo","year":"2023","journal-title":"EuroIntervention"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1016\/j.jacc.2018.02.029","article-title":"Pharmacogenomic approach to selecting antiplatelet therapy in patients with acute coronary syndromes: The PHARMCLO Trial","volume":"71","author":"Notarangelo","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1093\/eurheartj\/ehx419","article-title":"2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for Dual Antiplatelet Therapy in Coronary Artery Disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"39","author":"Valgimigli","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/eurheartj\/ehy394","article-title":"2018 ESC\/EACTS guidelines on myocardial revascularization","volume":"40","author":"Neumann","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1016\/S0140-6736(21)01445-8","article-title":"Unguided de-escalation from ticagrelor to clopidogrel in stabilised patients with acute myocardial infarction undergoing percutaneous coronary intervention (TALOS-AMI): An investigator-initiated, open-label, multicentre, non-inferiority, randomised trial","volume":"398","author":"Kim","year":"2021","journal-title":"Lancet"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"3070","DOI":"10.1093\/eurheartj\/ehx175","article-title":"Benefit of switching dual antiplatelet therapy after acute coronary syndrome: The TOPIC (timing of platelet inhibition after acute coronary syndrome) randomized study","volume":"38","author":"Cuisset","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1016\/S0140-6736(17)32155-4","article-title":"Guided de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention (TROPICAL-ACS): A randomised, open-label, multicentre trial","volume":"390","author":"Sibbing","year":"2017","journal-title":"Lancet"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1016\/S0140-6736(20)31791-8","article-title":"Prasugrel-based de-escalation of dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (HOST-REDUCE-POLYTECH-ACS): An open-label, multicentre, non-inferiority randomised trial","volume":"396","author":"Kim","year":"2020","journal-title":"Lancet"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1136\/heartjnl-2023-323097","article-title":"Optimal antiplatelet strategy following coronary artery bypass grafting: A meta-analysis","volume":"110","author":"Agrawal","year":"2024","journal-title":"Heart"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.amjcard.2017.09.022","article-title":"Meta-analysis of aspirin versus dual antiplatelet therapy following coronary artery bypass grafting","volume":"121","author":"Agarwal","year":"2018","journal-title":"Am. J. Cardiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.1161\/CIRCULATIONAHA.120.050749","article-title":"Effect of adding ticagrelor to standard aspirin on saphenous vein graft patency in patients undergoing coronary artery bypass grafting (POPular CABG): A randomized, double-blind, placebo-controlled trial","volume":"142","author":"Willemsen","year":"2020","journal-title":"Circulation"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1001\/jama.2018.3197","article-title":"Effect of ticagrelor plus aspirin, ticagrelor alone, or aspirin alone on saphenous vein graft patency 1 year after coronary artery bypass grafting: A randomized clinical trial","volume":"319","author":"Zhao","year":"2018","journal-title":"JAMA"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Wang, L., Zhao, Y., Zhang, S., Zhang, T., Song, J., Yun, Y., Wu, Y., Wang, Z., and Ma, X. (2025). Ticagrelor vs. clopidogrel in dual antiplatelet therapy after coronary artery bypass surgery: A meta-analysis. Front. Cardiovasc. Med., 12.","DOI":"10.3389\/fcvm.2025.1542437"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/j.jacc.2022.11.040","article-title":"Optimal antiplatelet therapy revisited: When is a single better than a double?","volume":"81","author":"Bhatt","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1093\/icvts\/ivab201","article-title":"Discontinuation of platelet inhibitors before elective cardiac surgery: A well-considered choice","volume":"33","author":"Gevaert","year":"2021","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.1161\/CIRCULATIONAHA.108.813667","article-title":"Safety of short-term discontinuation of antiplatelet therapy in patients with drug-eluting stents","volume":"119","author":"Eisenberg","year":"2009","journal-title":"Circulation"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2970","DOI":"10.1093\/eurheartj\/ehr151","article-title":"Safety of clopidogrel being continued until the time of coronary artery bypass grafting in patients with acute coronary syndrome: A meta-analysis of 34 studies","volume":"32","author":"Nijjer","year":"2011","journal-title":"Eur. Heart J."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2313","DOI":"10.1056\/NEJMoa2508026","article-title":"Ticagrelor and aspirin or aspirin alone after coronary surgery for acute coronary syndrome","volume":"393","author":"Jeppsson","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1001\/jama.2022.11966","article-title":"Association of dual antiplatelet therapy with ticagrelor with vein graft failure after coronary artery bypass graft surgery: A systematic review and meta-analysis","volume":"328","author":"Sandner","year":"2022","journal-title":"JAMA"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1007\/s11239-026-03250-2","article-title":"Ticagrelor-based antiplatelet therapy versus aspirin alone after coronary artery bypass grafting: A systematic review and meta-analysis with trial sequential analysis","volume":"59","author":"Bacha","year":"2026","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Yao, H., Qin, K., Liu, Y., Yang, Y., Zhu, J., Chen, A., Wang, Z., Ye, X., Zhou, M., and Li, H. (2022). CYP2C19 genotype and platelet aggregation test-guided dual antiplatelet therapy after off-pump coronary artery bypass grafting: A retrospective cohort study. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.1023004"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e020413","DOI":"10.1161\/JAHA.120.020413","article-title":"Dual antiplatelet therapy with clopidogrel and aspirin versus aspirin monotherapy in patients undergoing coronary artery bypass graft surgery","volume":"10","author":"Qu","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e009934","DOI":"10.1161\/JAHA.118.009934","article-title":"Off-pump coronary artery bypass grafting: 30 years of debate","volume":"7","author":"Gaudino","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1016\/j.athoracsur.2013.10.045","article-title":"Comparison of graft patency between off-pump and on-pump coronary artery bypass grafting: An updated meta-analysis","volume":"97","author":"Zhang","year":"2014","journal-title":"Ann. Thorac. Surg."},{"key":"ref_64","first-page":"753","article-title":"Impact of preoperative use of P2Y12 receptor inhibitors on clinical outcomes in cardiac and non-cardiac surgery: A systematic review and meta-analysis","volume":"6","author":"Petre","year":"2017","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1093\/ehjcvp\/pvac024","article-title":"Perioperative management of P2Y12 inhibitors in patients undergoing cardiac surgery within 1 year of PCI","volume":"8","author":"Cao","year":"2022","journal-title":"Eur. Heart J. Cardiovasc. Pharmacother."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"e012812","DOI":"10.1161\/JAHA.119.012812","article-title":"Early discontinuation of P2Y(12) antagonists and adverse clinical events post-percutaneous coronary intervention: A hospital and primary care linked cohort","volume":"8","author":"Harris","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1007\/s11239-012-0737-3","article-title":"Pharmacodynamic effects of cangrelor and clopidogrel: The platelet function substudy from the cangrelor versus standard therapy to achieve optimal management of platelet inhibition (CHAMPION) trials","volume":"34","author":"Angiolillo","year":"2012","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"e437","DOI":"10.1055\/s-0040-1721504","article-title":"Antiplatelet therapy with cangrelor in patients undergoing surgery after coronary stent implantation: A real-world bridging protocol experience","volume":"4","author":"Rossini","year":"2020","journal-title":"TH Open"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"2414","DOI":"10.1001\/jama.2019.8145","article-title":"Effect of 1-month dual antiplatelet therapy followed by clopidogrel vs 12-month dual antiplatelet therapy on cardiovascular and bleeding events in patients receiving PCI: The STOPDAPT-2 randomized clinical trial","volume":"321","author":"Watanabe","year":"2019","journal-title":"JAMA"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1056\/NEJMoa2108749","article-title":"Dual antiplatelet therapy after PCI in patients at high bleeding risk","volume":"385","author":"Valgimigli","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1016\/S0140-6736(18)30493-8","article-title":"6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): A randomised, open-label, non-inferiority trial","volume":"391","author":"Hahn","year":"2018","journal-title":"Lancet"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"e990","DOI":"10.4244\/EIJ-D-19-00539","article-title":"Final results of the randomised evaluation of short-term dual antiplatelet therapy in patients with acute coronary syndrome treated with a new-generation stent (REDUCE trial)","volume":"15","author":"Damen","year":"2019","journal-title":"EuroIntervention"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1056\/NEJMoa1908419","article-title":"Ticagrelor with or without aspirin in high-risk patients after PCI","volume":"381","author":"Mehran","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1866","DOI":"10.1016\/S0140-6736(24)00473-2","article-title":"Ticagrelor alone versus ticagrelor plus aspirin from month 1 to month 12 after percutaneous coronary intervention in patients with acute coronary syndromes (ULTIMATE-DAPT): A randomised, placebo-controlled, double-blind clinical trial","volume":"403","author":"Ge","year":"2024","journal-title":"Lancet"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.amjcard.2025.01.014","article-title":"Effectiveness and safety of ticagrelor monotherapy after short-duration dual antiplatelet therapy in PCI patients: A systematic review and meta-analysis","volume":"241","author":"Alagna","year":"2025","journal-title":"Am. J. Cardiol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1093\/ehjcvp\/pvad016","article-title":"Within and beyond 12-month efficacy and safety of antithrombotic strategies in patients with established coronary artery disease: Two companion network meta-analyses of the 2022 joint clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Association for Acute CardioVascular Care (ACVC), and European Association of Preventive Cardiology (EAPC)","volume":"9","author":"Navarese","year":"2023","journal-title":"Eur. Heart J. Cardiovasc. Pharmacother."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"e003083","DOI":"10.1136\/openhrt-2024-003083","article-title":"Parsimonious versus extensive bleeding score: Can we simplify risk stratification after percutaneous coronary intervention and reduce bleeding events by de-escalation of the antiplatelet strategy?","volume":"12","author":"Woelders","year":"2025","journal-title":"Open Heart"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"e016280","DOI":"10.1161\/CIRCINTERVENTIONS.125.016280","article-title":"Clopidogrel versus aspirin monotherapy beyond 1 year after PCI: The final 5-year results of the STOPDAPT-2 ACS and STOPDAPT-2 Total Cohort","volume":"19","author":"Watanabe","year":"2026","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1161\/CIRCULATIONAHA.122.062770","article-title":"Aspirin versus clopidogrel for long-term maintenance monotherapy after percutaneous coronary intervention: The HOST-EXAM extended study","volume":"147","author":"Kang","year":"2023","journal-title":"Circulation"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1016\/S0140-6736(25)00449-0","article-title":"Efficacy and safety of clopidogrel versus aspirin monotherapy in patients at high risk of subsequent cardiovascular event after percutaneous coronary intervention (SMART-CHOICE 3): A randomised, open-label, multicentre trial","volume":"405","author":"Choi","year":"2025","journal-title":"Lancet"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1001\/jamacardio.2024.4030","article-title":"Long-term aspirin vs clopidogrel after coronary stenting by bleeding risk and procedural complexity","volume":"10","author":"Kang","year":"2025","journal-title":"JAMA Cardiol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"e47773","DOI":"10.1097\/MD.0000000000047773","article-title":"Antiplatelet dilemma: Clopidogrel or aspirin for long-term cardiovascular protection after dual antiplatelet therapy following PCI","volume":"105","author":"Moawad","year":"2026","journal-title":"Medicine"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1056\/NEJMoa1817083","article-title":"Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation","volume":"380","author":"Lopes","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1007\/s11886-014-0485-4","article-title":"\u201cEast asian paradox\u201d: Challenge for the current antiplatelet strategy of \u201cone-guideline-fits-all races\u201d in acute coronary syndrome","volume":"16","author":"Jeong","year":"2014","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"e41723","DOI":"10.1016\/j.heliyon.2025.e41723","article-title":"Female sex is associated with short-term mortality in coronary artery bypass grafting patients: A propensity-matched analysis","volume":"11","author":"Abbas","year":"2025","journal-title":"Heliyon"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1093\/ehjcvp\/pvaf034","article-title":"Sex-related variations in platelet reactivity in presence or absence of antiplatelet therapy","volume":"11","author":"Galli","year":"2025","journal-title":"Eur. Heart J. Cardiovasc. Pharmacother."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1124\/mol.110.065540","article-title":"Regulation of CYP2C19 expression by estrogen receptor \u03b1: Implications for estrogen-dependent inhibition of drug metabolism","volume":"78","author":"Mwinyi","year":"2010","journal-title":"Mol. Pharmacol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"2001","DOI":"10.1056\/NEJMoa0706482","article-title":"Prasugrel versus clopidogrel in patients with acute coronary syndromes","volume":"357","author":"Wiviott","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1056\/NEJMoa0904327","article-title":"Ticagrelor versus clopidogrel in patients with acute coronary syndromes","volume":"361","author":"Wallentin","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1093\/eurheartj\/ehaf473","article-title":"Sex differences in dual antiplatelet therapy de-escalation strategies after percutaneous coronary intervention: A network meta-analysis","volume":"47","author":"Occhipinti","year":"2026","journal-title":"Eur. Heart J."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"e351","DOI":"10.1161\/CIR.0000000000001285","article-title":"2024 AHA\/ACC\/ACS\/ASNC\/HRS\/SCA\/SCCT\/SCMR\/SVM guideline for perioperative cardiovascular management for noncardiac surgery: A report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"150","author":"Thompson","year":"2024","journal-title":"Circulation"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1051\/ject\/202153097","article-title":"STS\/SCA\/AmSECT\/SABM update to the clinical practice guidelines on patient blood management","volume":"53","author":"Tibi","year":"2021","journal-title":"J. Extracorpor. Technol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"e207","DOI":"10.1016\/j.chest.2022.07.025","article-title":"Perioperative management of antithrombotic therapy: An American College of Chest Physicians clinical practice guideline","volume":"162","author":"Douketis","year":"2022","journal-title":"Chest"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1016\/j.jacc.2021.08.013","article-title":"Bridging antiplatelet therapy after percutaneous coronary intervention: JACC Review Topic of the Week","volume":"78","author":"Sullivan","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"e017540","DOI":"10.1136\/bmjopen-2017-017540","article-title":"MEDication reminder APPs to improve medication adherence in Coronary Heart Disease (MedApp-CHD) Study: A randomised controlled trial protocol","volume":"7","author":"Santo","year":"2017","journal-title":"BMJ Open"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1038\/s41746-018-0029-1","article-title":"Scalable and accurate deep learning with electronic health records","volume":"1","author":"Rajkomar","year":"2018","journal-title":"npj Digit. Med."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12929-024-01110-w","article-title":"Unlocking precision medicine: Clinical applications of integrating health records, genetics, and immunology through artificial intelligence","volume":"32","author":"Chen","year":"2025","journal-title":"J. Biomed. Sci."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/4870\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T04:02:44Z","timestamp":1782273764000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/4870"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,23]]},"references-count":97,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15134870"],"URL":"https:\/\/doi.org\/10.3390\/jcm15134870","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,23]]}}}