title: Optimal duration of dual antiplatelet therapy after coronary stent implantation.
abstract: Dual antiplatelet pharmacotherapy reduces ischemic events at the cost of excess bleeding in patients who underwent coronary stenting. The currently recommended treatment period is based on trials held some 20 years ago and not relevant to current clinical practice. In recent years, numerous clinical trials have tried to answer the question of what is the optimal duration of therapy to maximize clinical benefit. These trials showed 2 seemingly conflicting answers-on one hand, shorter treatment duration seems to be safer in reducing bleeding while not increasing ischemic events, and on the other hand, longer duration is superior in terms of preventing ischemic events albeit at the cost of increased bleeding rates. In this review, we summarize the evidence favoring each approach, highlight the limitations of the various pivotal clinical trials in this field, review future directions of research and changes in practice that may influence the duration of antiplatelet therapy, and attempt to propose a personalized approach to achieve maximal benefit for the individual patient.
authors.affiliation: Department of cardiology, Rabin Medical Center, Petah Tikva, Israel. Electronic address: vitberguy@gmail.com.
authors.forename: Guy
authors.initials: G
authors.lastname: Witberg
authors.affiliation: Department of cardiology, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Eli
authors.initials: E
authors.lastname: Lev
authors.affiliation: Department of cardiology, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
mesh_terms: D023903:Coronary Restenosis / Q000517:prevention & control*; D004334:Drug Administration Schedule; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011182:Postoperative Care / Q000379:methods*; D015607:Stents; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors