Key result
Extended dual antiplatelet therapy beyond 12 months reduces stent thrombosis and myocardial infarction but increases the risk of major bleeding and all-cause mortality compared to shorter durations.
Why the study?
Does the duration of dual antiplatelet therapy affect ischaemic and bleeding events in patients after drug-eluting stent implantation?
Does the duration of dual antiplatelet therapy affect ischaemic and bleeding events in patients after drug-eluting stent implantation?
This review highlights the trade-off between ischaemic benefit and bleeding risk when determining the optimal duration of DAPT after DES implantation, noting that newer generation DES may allow for safe short-term DAPT.
May warrant individualized DAPT duration balancing ischemic benefit against bleeding risk; leaves open optimal strategy with newer stents.
Early discontinuation of dual antiplatelet therapy (DAPT) has been identified as a risk factor for late stent thrombosis after the implantation of drug-eluting stents (DES). Different durations of DAPT have been evaluated in observational studies and randomised controlled trials, but the results on the risk of ischaemic and bleeding events have been variable and controversial. Although extended DAPT shows an ischaemic benefit, it is associated with increased bleeding risk, while short-term DAPT has been suggested to be safe in recent trials with the newer generation of DES. Uncertainty regarding the optimal duration of DAPT makes clinical decisions challenging. In this review, evidence from the latest clinical trials on the duration of DAPT after DES implantation and the factors that affect DAPT duration is examined to find the optimal balance between thrombotic and bleeding risks, which would be a useful guide to clinical practice.
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Cheung et al. (2017) conducted a review in Coronary artery disease requiring drug-eluting stent implantation. Dual antiplatelet therapy (DAPT) vs. Shorter vs longer durations was evaluated. Extended dual antiplatelet therapy beyond 12 months reduces stent thrombosis and myocardial infarction but increases the risk of major bleeding and all-cause mortality compared to shorter durations.
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