Dual antiplatelet therapy after coronary stenting.
BACKGROUND
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor represents the mainstay of pharmacotherapy in patients undergoing coronary stenting. Currently, three P2Y12 receptor inhibitors are approved for clinical use, including clopidogrel, prasugrel, and ticagrelor, with the latter two being preferred in patients presenting with an acute coronary syndrome. The introduction into clinical practice of newer-generation drug-eluting stent (DES) with safer profiles (i.e. less stent thrombosis) compared with earlier platforms have led recent guideline updates to re-evaluate the optimal duration of DAPT therapy, which are now based on evidence of a multitude of randomized clinical trials, registries, and meta-analysis and take into consideration the ischemic and bleeding risk profile of the patients.


METHODS
Most recent updates on DAPT duration from professional societies in the United States and Europe are discussed. Moreover, an assessment of clinical trials, registries, and meta-analysis leading to changes on practice guidelines analyzed.


CONCLUSIONS
The widespread introduction into clinical practice of newer-generation DES allows for shortening DAPT duration as also endorsed by practice guidelines. However, the optimal duration of DAPT therapy varies according to the individuals' risk of ischemic and bleeding complications, with longer or shorter durations of treatment, respectively, that may be considered.
a Division of Cardiology, University of Florida College of Medicine - Jacksonville , Jacksonville , FL , USA.|b Department of Internal Medicine , Gyeongsang National University School of Medicine and Gyeongsang National University Hospital , Jinju , Korea.
Yongwhi
Y
Park
a Division of Cardiology, University of Florida College of Medicine - Jacksonville , Jacksonville , FL , USA.
Francesco
F
Franchi
a Division of Cardiology, University of Florida College of Medicine - Jacksonville , Jacksonville , FL , USA.
Fabiana
F
Rollini
a Division of Cardiology, University of Florida College of Medicine - Jacksonville , Jacksonville , FL , USA.
Dominick J
DJ
Angiolillo
D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D054855:Drug-Eluting Stents / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
Antiplatelet therapy; coronary artery disease; coronary stent; duration of antiplatelet therapy