In order to reduce the risk of recurrent atherothrombotic thrombus, domestic and international guidelines recommend that patients receive aspirin combined with P2Y12 inhibitor dual antiplatelet therapy (DAPT) for at least 12 months after the occurrence of acute coronary syndrome (ACS). However, the existing evidence suggests that the risk of residual ischemia in ACS patients will last for more than 12 months, and the benefits of prolonging DAPT treatment in patients with special ACS (with high risk of bleeding) are still controversial. The purpose of this review is to provide an individualized and accurate treatment plan for the patients based on the pathophysiological mechanism of ACS, combined with stent type and risk stratification system to fully evaluate the bleeding risk and anti-ischemic event benefit of DAPT, and maximize the benefit/risk ratio.