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July 18, 2023LifeOpen Access

Dual Antiplatelet Therapy: A Concise Review for Clinicians

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Why the study?

Emerging data on DAPT duration are continuously published, and new approaches aim to balance ischemic benefits and bleeding risks across established cardiovascular diseases.

How does the duration and combination of dual antiplatelet therapy balance ischemic protection and bleeding risk across different cardiovascular disease scenarios?

Population

Patients with atherosclerotic cardiovascular diseases

Design

Review

Authors

HVHafeez Ul Hassan VirkJEJohao EscobarMRMario Rodríguez

Discussion

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Overview

Individualizes DAPT duration post-ACS PCI by ischemic-bleeding balance; literature review leaves open patient-specific RCTs.

Key Points

  • Summarize clinical evidence regarding the efficacy, safety, and optimal duration of dual antiplatelet therapy across various cardiovascular conditions.
  • Reviewed clinical data evaluating short-term (1 to 6 months) versus extended (>12 months) dual antiplatelet regimens.
  • Evaluated ischemic benefits and bleeding complications across acute coronary syndrome, stable coronary disease, peripheral artery disease, and structural heart interventions.
  • Short-term DAPT (1–6 months) provides efficacy equivalent to long-term regimens after percutaneous coronary intervention for acute coronary syndromes, while regimens exceeding 12 months reduce stent thrombosis and myocardial infarction but increase bleeding.
  • Extended DAPT does not reduce stroke, myocardial infarction, or cardiovascular mortality in stable coronary artery disease, though ticagrelor combined with aspirin lowers cardiovascular events in patients with comorbid diabetes.
  • Aspirin monotherapy is preferred following transcatheter aortic valve implantation and bypass surgery, whereas combination antiplatelet therapy yields superior outcomes in secondary prevention of stroke or transient ischemic attack.

Structured PICO

How does the duration and combination of dual antiplatelet therapy balance ischemic protection and bleeding risk across different cardiovascular disease scenarios?

P
Population
Patients with atherosclerotic cardiovascular diseases, including acute coronary syndrome post-percutaneous coronary intervention, stable coronary artery disease, atrial fibrillation post-percutaneous coronary intervention, post-coronary artery bypass graft, transcatheter aortic valve implantation, peripheral artery disease, and carotid artery disease.
I
Intervention
Dual antiplatelet therapy (DAPT) of varying durations (short-term 1-6 months, prolonged >12 months) and specific combinations (e.g., aspirin with clopidogrel or ticagrelor, addition of vorapaxar or cilostazol).
C
Comparator
Standard duration DAPT, aspirin monotherapy, or alternative antiplatelet regimens depending on the specific clinical scenario.
O
Outcome
Balance of efficacy (reduction in stent thrombosis, major adverse cardiovascular events, myocardial infarction, stroke, cardiovascular death) and safety (bleeding risk).

The optimal duration and composition of dual antiplatelet therapy must be highly individualized based on the specific cardiovascular condition and the patient's balance of ischemic versus bleeding risks.

Cite This Study

Virk et al. (2023) studied this question.

synapsesocial.com/papers/69a3048aa60bae612d55e47dhttps://doi.org/10.3390/life13071580
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Strategies to Optimize Dual Antiplatelet Therapy After Coronary Artery Stenting in Acute Coronary Syndrome2016 · 13 citations
  2. 2Dual Antiplatelet Therapy (DAPT) in Coronary Artery Disease: A Daunting Dilemma2018 · 2 citations
  3. 3Dapt Review2020 · 1 citations
  4. 4Long-term dual antiplatelet therapy: pharmacological and clinical implications2018 · 3 citations
  5. 5Dual antiplatelet therapy for secondary prevention of coronary artery disease2017 · 75 citations