Duration of Dual Antiplatelet Therapy after Implantation of Drug-Eluting Stents

Abstract

The use of dual antiplatelet therapy for a period longer than 12 months in patients who had received drug-eluting stents was not significantly more effective than aspirin monotherapy in reducing the rate of myocardial infarction or death from cardiac causes. These findings should be confirmed or refuted through larger, randomized clinical trials with longer-term follow-up. (ClinicalTrials.gov numbers, NCT00484926 and NCT00590174.)

Optimal duration of dual antiplatelet therapy after drug-eluting stent implantation: Meta-analysis of randomized controlled trials

“…ACCEPTED MANUSCRIPT 12 Our meta-analysis and other recent meta-analyses [27][28][29] have provided evidence that extended DAPT can significantly lower the incidence of myocardial infarction and stent thrombosis. There is no effective alternative to DAPT for preventing stent thrombosis after DES implantation, but there are ways of reducing bleeding risk, such as risk stratification, blood pressure control and prophylaxis with proton pump inhibitor.…”

“…Recent trials with newer generation DES have suggested that short-term DAPT is safe, and can therefore replace 12 months' therapy [5][6][7][8][9][10][11]. Whether extended duration of DAPT over 12 months is superior has also been questioned; inconsistent results were found in clinical trials comparing different durations of DAPT [12][13][14][15][16]. In general, short-term DAPT (<12 months) is associated with a lower frequency of major bleeding, but early discontinuation of DAPT could increase the risk of late stent thrombosis [17][18][19].…”

Optimal Medical Therapy, Lifestyle Intervention, and Secondary Prevention Strategies for Cardiovascular Event Reduction in Ischemic Heart Disease

“…The CHARISMA study did not report any significant benefit with aspirin and clopidogrel compared to aspirin alone in patients with either established CAD or at high risk for a CV event, although a marginal reduction in CV death, MI, or stroke (6.9% vs 7.9%; P=0.045) was observed with dual antiplatelet therapy in the subset of patients with established CAD [29]. A combined analysis of two studies comparing aspirin and clopidogrel to aspirin alone in 2701 participants post 1-year PCI with a DES also failed to report any benefit of dual antiplatelet therapy [30]. After a mean follow-up of 19.2 months post randomization and 33.2 months post procedure, there was no difference in the primary outcome of MI or CV death between the dual and single antiplatelet groups (1.8% vs 1.2%; P=0.17).…”

Focused Clinical Review: Periprocedural Management of Antiplatelet Therapy in Patients with Coronary Stents

“…Over 4500 patients were assessed at six months and 12 months post BMS and DES implantation. Amongst patients with DES who were event free at six months, continued clopidogrel use was a significant pre- [27]. Randomised clinical trials comparing dual antiplatelet therapy duration are currently ongoing.…”