Key result
Shortened 1-to-3-month DAPT with clopidogrel balances ischemic and bleeding risks in cancer patients.
Why the study?
Malignancy predisposes patients to both thrombosis and hemorrhage, making the administration and duration of DAPT a clinical challenge in cancer patients.
Due to overlapping pro-thrombotic and pro-hemorrhagic states in cancer, a personalized approach with a shortened DAPT duration (1-3 months, predominantly aspirin and clopidogrel) is advised for cardiovascular interventions.
Supports individualized shortened DAPT in cancer patients; leaves open confirmation by randomized trials before practice change.
Cardiovascular (CV) events in patients with cancer can be caused by concomitant CV risk factors, cancer itself, and anticancer therapy. Since malignancy can dysregulate the hemostatic system, predisposing cancer patients to both thrombosis and hemorrhage, the administration of dual antiplatelet therapy (DAPT) to patients with cancer who suffer from acute coronary syndrome (ACS) or undergo percutaneous coronary intervention (PCI) is a clinical challenge to cardiologists. Apart from PCI and ACS, other structural interventions, such as TAVR, PFO-ASD closure, and LAA occlusion, and non-cardiac diseases, such as PAD and CVAs, may require DAPT. The aim of the present review is to review the current literature on the optimal antiplatelet therapy and duration of DAPT for oncologic patients, in order to reduce both the ischemic and bleeding risk in this high-risk population.
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Tsigkas et al. (2023) conducted a review in Cancer patients requiring antiplatelet therapy (e.g., for acute coronary syndrome, percutaneous coronary intervention, structural interventions, or non-cardiac vascular diseases). Dual antiplatelet therapy (DAPT) was evaluated. A shortened dual antiplatelet therapy duration of 1 to 3 months, primarily utilizing aspirin and clopidogrel, is recommended for cancer patients to balance the concurrently elevated ischemic and bleeding risks.
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