What is the clinical evidence from this study?

Study design: Review. Population: Coronary artery disease. Intervention: Dual antiplatelet therapy (DAPT) vs. Standard duration DAPT.

April 30, 2018Open Access

Optimal duration of dual antiplatelet therapy for coronary artery disease

WKWouter J. KikkertInterventional Cardiology PDPeter DammanInterventional Cardiology

Key Result

Personalized dual antiplatelet therapy (DAPT) duration based on ischemic and bleeding risks is recommended, with 3-6 months reasonable for low ischemic risk and extended DAPT for high ischemic risk.

Structured PICO

Does personalized duration of DAPT (short or extended) improve net clinical outcomes compared to standard 12-month DAPT in patients with CAD?

Population

Patients with stable coronary artery disease and acute coronary syndrome

Intervention

Short duration DAPT (3-6 months) or extended duration DAPT (>12 months)

Comparator

Standard duration DAPT (12 months)

Outcome

Net clinical outcome (ischemic and bleeding events)composite

Defining the optimal duration of dual antiplatelet therapy for the individual patient requires careful assessment of ischemic and hemorrhagic risk.

Limitations

Short-term DAPT trials were often underpowered to detect differences in hard clinical endpoints.
Randomization at the time of PCI rather than DAPT discontinuation in some trials may have diluted differences in ischemic events.
Current risk scores are not comprehensive and require complete analysis of patient and procedural factors.

Abstract

The optimal duration of dual antiplatelet therapy (DAPT) for stable coronary artery disease and acute coronary syndrome is a complex decision. We review current literature on standard duration DAPT versus short duration DAPT (6 months or shorter) or extended duration DAPT (>12 months) after percutaneous coronary intervention with drug-eluting stent placement, and prolonged treatment after 12 months in acute coronary syndrome. Current guideline recommendations are summarised, including the use of risk scores for ischaemic and bleeding risk assessment. Because of the limitations of current risk scores, we propose multiple patient-related and procedure-related factors for the ischaemic and bleeding risk assessment aiding in personalised DAPT duration.

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