Duration of Dual Antiplatelet Therapy in Coronary Artery Disease: a Review Article.
Dual antiplatelet therapy (DAPT) following an acute coronary syndrome or after placement of a coronary artery stent is superior to aspirin alone for prevention of atherothrombotic events but carries an increased bleeding risk. DAPT should be continued for at least 12 months based on current guidelines. Recent randomized trials demonstrate reduced ischemic events including myocardial infarction (MI), stroke, and death with continued DAPT for up to 30 months or longer, particularly in the post-MI population. However, this clinical benefit is accompanied by an increased risk of bleeding. Additional trials show mixed safety and efficacy with duration of DAPT of less than 12 months. The current data emphasizes the need to individualize DAPT duration at the patient level to balance the clinical benefits of a reduced risk of cardiovascular ischemic events with the greater risk of clinically significant bleeding. Patients at an increased risk of ischemic events and a lower risk of bleeding should be strongly considered for prolonged DAPT beyond the 1 year currently recommended in the practice guidelines.
Rush University Medical Center, 1653 W Congress Parkway, Chicago, IL, 60612, USA.
Alex D
AD
Moseley
Rush University Medical Center, 1653 W Congress Parkway, Chicago, IL, 60612, USA.
Fareed M
FM
Collado
Rush University Medical Center, 1653 W Congress Parkway, Chicago, IL, 60612, USA.
Annabelle Santos
AS
Volgman
Rush University Medical Center, 1653 W Congress Parkway, Chicago, IL, 60612, USA.
Gary L
GL
Schaer
Rush University Medical Center, 1653 W Congress Parkway, Chicago, IL, 60612, USA. Jeffrey_snell@rush.edu.
R Jeffrey
RJ
Snell
D003324:Coronary Artery Disease / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012306:Risk; D020521:Stroke / Q000517:prevention & control
D010975:Platelet Aggregation Inhibitors
Coronary artery disease; Dual antiplatelet therapy