It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change. (Charles Darwin)

Despite being proposed more than three decades ago, dual antiplatelet therapy has become a cornerstone of medical treatment for patients suffering from acute coronary syndrome after the introduction of bare metal stents to overcome the risk of restenosis and stent thrombosis associated with such devices. With the advent of drug-eluting stents and the related risk of late stent thrombosis, an indication to extend dual antiplatelet therapy duration up to 12 months after acute coronary syndrome was established and has been regarded as a dogma for many years.1 The advent of new-generation drug-eluting stents, with structural properties supposed to reduce endothelial inflammation and promote faster re-endothelisation,2 along with the increasing evidence about the global ischaemic risk of patients experiencing acute coronary syndrome, led to a paradigm shift in the way the dual antiplatelet therapy is conceived in the clinical practice, playing a role to prevent from non-stent-related atherothrombotic events over long term. However, the rising knowledge that bleeding events that are invariably associated with dual antiplatelet therapy have a detrimental impact on prognosis at least as relevant as recurrent ischaemic events has cast doubts about the ‘one-size fits all’ approach of a standard dual antiplatelet therapy intensity and duration after acute coronary syndrome.3 In the era of personalised medicine, the need for a tailored dual antiplatelet therapy strategy has been advocated from more sides. For this purpose, research efforts focused on the development of risk scores able to …