Key result
Tailoring DAPT in ACS requires using validated scores to balance ischemic and bleeding risks.
Why the study?
Recent randomized trial evidence has shifted guideline recommendations regarding optimal DAPT composition and duration in ACS patients treated with percutaneous coronary angioplasty, requiring guidance on tailoring strategies based on bleeding and ischemic risk.
How should dual antiplatelet therapy (DAPT) duration and composition be tailored based on ischemic and bleeding risk in patients with acute coronary syndrome treated with percutaneous coronary angioplasty?
How should dual antiplatelet therapy (DAPT) duration and composition be tailored based on ischemic and bleeding risk in patients with acute coronary syndrome treated with percutaneous coronary angioplasty?
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This review highlights the paradigm shift towards individualized DAPT strategies in ACS patients undergoing PCI, guided by specific bleeding and ischemic risk assessments.
The assessment of bleeding and ischemic risk is a crucial step in establishing appropriate composition and duration of dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS) treated with percutaneous coronary angioplasty. Evidence from recent randomized clinical trials led to some paradigm shifts in current guidelines recommendations. Options alternative to the standard 12-month DAPT duration include shorter periods of DAPT followed by single antiplatelet treatment with either aspirin or P2Y12 monotherapy, guided or unguided de-escalation DAPT, prolonged DAPT beyond the 12-month treatment period. Although DAPT composition and duration should be selected for each ACS patient on an individual basis weighing clinical and procedural variables, data from latest trials and meta-analyses may permit suggesting the most appropriate DAPT strategy according to the ischemic and bleeding risk assessed using validated tools and scores.
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Servi et al. (2022) conducted a review in Acute coronary syndrome (ACS). Tailored dual antiplatelet therapy (DAPT) vs. Standard 12-month DAPT was evaluated. Tailoring dual antiplatelet therapy duration and composition in acute coronary syndrome patients should be individualized based on ischemic and bleeding risks using validated tools and scores.
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