The optimal duration of dual antiplatelet therapy after coronary stent implantation: to go too far is as bad as to fall short.

Costa, Francesco; Valgimigli, Marco (2018). The optimal duration of dual antiplatelet therapy after coronary stent implantation: to go too far is as bad as to fall short. Cardiovascular diagnosis and therapy, 8(5), pp. 630-646. AME Publishing Company 10.21037/cdt.2018.10.01

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Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is key for secondary prevention of recurrent coronary ischemic events and stent thrombosis. For this purpose, DAPT showed superior efficacy compared to aspirin alone, but it is also associated with an increased risk of major, and potentially fatal, bleeding. Hence, while secondary prevention with aspirin monotherapy is generally maintained for an indefinite period, the duration of DAPT after the index event is still debated. Multiple trials have challenged the guideline recommended standard of care of 12 months of DAPT duration. These studies tested on one side a treatment reduction to 6 or 3 months, and on the other side an extension of treatment beyond 12 months in order to define the optimal DAPT duration maximizing the anti-ischemic protection and minimizing bleeding. In this document we sought to summarize the existing evidence from more than 18 randomized controlled trials in the field, and discuss the benefit and risks of prolonging/shortening DAPT duration. In addition, a specific focus on treatment individualization will outline the current, evidence-based, decision-making process for optimal DAPT duration selection after coronary stenting.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Valgimigli, Marco

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2223-3652

Publisher:

AME Publishing Company

Language:

English

Submitter:

Amanda Valle

Date Deposited:

22 Feb 2019 12:43

Last Modified:

05 Dec 2022 15:24

Publisher DOI:

10.21037/cdt.2018.10.01

PubMed ID:

30498687

Uncontrolled Keywords:

DAPT duration Dual antiplatelet therapy (DAPT) PRECISE-DAPT bleeding coronary stenting

BORIS DOI:

10.7892/boris.124012

URI:

https://boris.unibe.ch/id/eprint/124012

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