title: Duration of dual antiplatelet therapy in acute coronary syndrome.
abstract: Despite a large volume of evidence supporting the use of dual antiplatelet therapy in patients with acute coronary syndrome, there remains major uncertainty regarding the optimal duration of therapy. Clinical trials have varied markedly in the duration of therapy, both across and within trials. Recent systematic reviews and meta-analyses suggest that shorter durations of dual antiplatelet therapy are superior because the avoidance of atherothrombotic events is counterbalanced by the greater risks of excess major bleeding with apparent increases in all-cause mortality with longer durations. These findings did not show significant heterogeneity according to whether patients had stable or unstable coronary heart disease. Moreover, the potential hazards and benefits may differ when applied to the general broad population of patients encountered in everyday clinical practice who have markedly higher bleeding and atherothrombotic event rates. Clinicians lack definitive information regarding the duration of therapy in patients with acute coronary syndrome and risk scores do not appear to be sufficiently robust to address these concerns. We believe that there is a pressing need to undertake a broad inclusive safety trial of shorter durations of therapy in real world populations of patients with acute coronary syndrome. The clinical evidence would further inform future research into strategies for personalised medicine.
authors.affiliation: British Heart Foundation Centre for Cardiovascular Science, New Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Simon John
authors.initials: SJ
authors.lastname: Wilson
authors.affiliation: British Heart Foundation Centre for Cardiovascular Science, New Royal Infirmary of Edinburgh, Edinburgh, UK d.e.newby@ed.ac.uk.
authors.forename: David E
authors.initials: DE
authors.lastname: Newby
authors.affiliation: Department of Cardiovascular Medicine, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen.
authors.forename: Dana
authors.initials: D
authors.lastname: Dawson
authors.affiliation: Department of Cardiology, Ninewells Hospital, Dundee, UK.
authors.forename: John
authors.initials: J
authors.lastname: Irving
authors.affiliation: British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Berry
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D001792:Blood Platelets / Q000187:drug effects* / Q000378:metabolism; D003328:Coronary Thrombosis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D058925:Receptors, Purinergic P2Y12 / Q000097:blood / Q000187:drug effects*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C548576:P2RY12 protein, human; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12; D001241:Aspirin
keywords: Acute coronary syndromes; Coronary artery disease; Diseases