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What is the optimal duration of dual antiplatelet therapy?
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According to the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, the risk of stent thrombosis is increased dramatically in patients who prematurely discontinue dual antiplatelet therapy earlier than recommended.
Dual antiplatelet therapy (DAPT) is generally recommended for the first 14 to 30 days for patients who received a bare metal stent (BMS) because this is the period for which the risk of stent thrombosis with a BMS is greatest.
For patients who received a DES, consensus in clinical practice is to prescribe DAPT to these patients for at least 12 months.
The guidelines recommend assessing the ability and willingness of each patient to remain on the DAPT for the recommended amount of time when deciding whether to use PCI for each patient.
However, the optimal duration of dual antiplatelet therapy following PCI may still be unclear. Some recent studies have examined this question.
In a randomized controlled trial published in the October 2013 edition of Circulation, researchers examined weather an additional 24 months of DAPT compared with aspirin alone was beneficial for patients who were prescribed DAPT for 12 months following PCI and had no complications. The researchers concluded that an additional 24 months following the initial 12 months of DAPT had no significant benefit with regard to the risk of the composite end point of death from cardiac causes, myocardial infarction or stroke, compared with aspirin alone during the extra 24 months.
Results of a trial published in the Journal of the American College of Cardiology, and presented at the 26th annual Transcatheter Cardiovascular Therapeutics (TCT) Scientific Symposium 2014, in Washington, D.C., showed that patients who received 6 months of DAPT after receiving a second-generation drug-eluting stent (DES) seemed to have similar outcomes to patients who received DAPT for a full year, according to a Cardiovascular Research Foundation press release.
In a meta-analysis of three randomized trials (n=6,679 patients) published in The Journal of Cardiovascular Pharmacology in July 2014, researchers assessed the optimal duration of DAPT after DES implantation. They concluded that there were no significant differences between short-term DAPT and standard-term DAPT. The researchers included endpoints of incidences of cardiac death, myocardial infarction, stent thrombosis and target vessel revascularization. The researchers also concluded that short-term DAPT did not increase the risk of all-cause death, cerebrovascular accidents, and major bleeding events.
The optimal duration of dual antiplatelet therapy continues to be debated.
Additional information may be found in these references or at these websites:
Levine GN. J Am Coll Cardiol. 2011;doi:10.1016/j.jacc.2011.08.007.
Lee CW. Circulation. 2013;doi:10.1161/CIRCULATIONAHA.113.003303.
Liu M. J Cardiovasc Pharmacol. 2014;doi:10.1097/FJC.0000000000000088.