The optimal duration of dual antiplatelet therapy in patients receiving percutaneous coronary intervention with drug-eluting stents

Abstract

There was no difference in efficacy outcomes between short-term and long-term DAPT following DES, even among high-risk patients. However, longer duration of DAPT was found to be associated with increased risk of major bleeding.

2018 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Focused Update of the Guidelines for the Use of Antiplatelet Therapy

“…7,[9][10][11][12]26,27 Fifteen published meta-analyses compared 3-6 months vs 12 months of DAPT. [28][29][30][31][32][33][34][35][36][37][38][39] A consistent finding was that lower rates of bleeding were associated with shorter courses of DAPT. [28][29][30][31][32][33][34][35]38 Thirteen meta-analyses showed no difference in ischemic or thrombotic end points with shorter courses of DAPT.…”

“…[28][29][30][31][32][33][34][35][36][37][38][39] A consistent finding was that lower rates of bleeding were associated with shorter courses of DAPT. [28][29][30][31][32][33][34][35]38 Thirteen meta-analyses showed no difference in ischemic or thrombotic end points with shorter courses of DAPT. 29,[31][32][33][34][35][36] Meta-analyses have also evaluated longer vs shorter durations of DAPT in various patient subgroups, in which a consistent finding was that a shorter duration of DAPT might give rise to an increased risk of ischemic outcomes.…”

Treatment of patients with acute coronary syndrome: Recommendations for medical emergency teams: Focus on antiplatelet therapies. Updated experts’ standpoint

“…The current recommendations concerning the treatment of patients with ACS emphasize the need to use DAPT for 12 months following ACS, unless contraindicated due to an excessive risk of bleeding -class of recommendation I, level of evidence A. This recommendation is valid for patients both with STEMI and NSTE-ACS [2,10,36,37].…”

Operator, Drug or Device: Who Will Break Down Acute Stent Thrombosis?

“…The introduction of the dual antiplatelet treatment, from ticlopidine to ticagrelor and prasugrel, through clopidogrel, significantly reduced the ST occurrence [2]. Especially, newer P2Y12 inhibitors showed a high efficacy with an overall good profile of safety and tolerability [2,3]. In addition, it is plausible that in the near future new drugs and regimens will be available that will ensure a further reduction of ST occurrence (NCT01813435 and NCT02293395).…”

“…The latter conditions are particularly related to drugs and devices. The introduction of the dual antiplatelet treatment, from ticlopidine to ticagrelor and prasugrel, through clopidogrel, significantly reduced the ST occurrence [2]. Especially, newer P2Y12 inhibitors showed a high efficacy with an overall good profile of safety and tolerability [2,3].…”