title: Long-term antiplatelet therapy:  from clinical trials to clinical application.
abstract: OBJECTIVE
  This review seeks to describe the emerging clinical trial data that informs clinical practice with regards to dual antiplatelet therapy.
  
  
  RESULTS
  Recent evidence with vorapaxar has demonstrated an increase in bleeding events with only modest improvement in ischemic outcomes. Platelet function testing to inform clopidogrel dose selection has not shown improvement in clinical outcome. The impact of CYP2C19 loss-of-function alleles on clopidogrel effect may be more modest than initially reported, though an impact on stent thrombosis is evident. Among patients receiving current generation drug eluting stents, 6 months of dual antiplatelet therapy may provide similar ischemic outcomes with fewer bleeding events compared with 12 or 24 months of therapy. Novel anticoagulants entering clinical practice will also potentially influence the clinical decisions regarding the duration of dual antiplatelet therapy. Studies focussing on the discontinuation of aspirin as opposed to the P2Y12 inhibitor to reduce late bleeding risk should be considered.
  
  
  CONCLUSIONS
  Evolving evidence and new therapies may enable shorter duration dual antiplatelet therapy.
authors.affiliation: Flinders University, Adelaide, South Australia, Australia. derek.chew@flinders.edu.au
authors.forename: Derek P
authors.initials: DP
authors.lastname: Chew
authors.forename: Leong
authors.initials: L
authors.lastname: Lee
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000235:genetics / Q000628:therapy; D000483:Alleles; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics; D002986:Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000235:genetics / Q000628:therapy; D065731:Cytochrome P-450 CYP2C19; D054855:Drug-Eluting Stents; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D058925:Receptors, Purinergic P2Y12 / Q000235:genetics; D012307:Risk Factors; D013997:Time Factors; D057170:Translational Research, Biomedical
chemical_list: D000925:Anticoagulants; C548576:P2RY12 protein, human; D010975:Platelet Aggregation Inhibitors; D058925:Receptors, Purinergic P2Y12; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19