Duration of Dual Antiplatelet Therapy After Coronary Stenting

E-ISSN： 1873-4286|22|29|4583-4595

ISSN： 1381-6128

Source： Current Pharmaceutical Design, Vol.22, Iss.29, 2016-09, pp. : 4583-4595

Disclaimer: Any content in publications that violate the sovereignty, the constitution or regulations of the PRC is not accepted or approved by CNPIEC.

Previous Menu Next

Abstract

Background: Dual antiplatelet therapy (DAPT) is one of the cornerstones ofcoronary artery disease (CAD) treatment. Standard DAPT requires one of, P2Y12 receptorinhibitors, clopidogrel, prasugrel or ticagrelor as an adjunct therapy to aspirin administration.The decision over DAPT duration depends on the evaluation of thrombotic risk and theassessment of the probability for major bleeding events. Methods: The goal of this work wasto identify which would be the appropriate combination of antiplatelet agents and the optimalduration of DAPT, based on the patient’s medical history and clinical characteristics. Athorough search of PubMed and the Cochrane Database was conducted in order to identifyrandomized controlled trials, observational studies, current ESC and ACC/AHA guidelinesand novel articles on the subject. Results: The decision over DAPT duration is based on acareful approach which requires the evaluation of thrombotic risk and the assessment of theprobability for major bleeding events. A series of aspects and special conditions may influencethe duration of DAPT after stenting e.g. the type of the implanted stent (DES or BMS) or if the commencementof DAPT is administered in the context of an acute coronary syndrome or in the setting of stable CAD.Current guidelines can assist clinicians in making decisions but treating patients in special groups e.g. with diabetesmellitus or the elderly people can be very demanding. Conclusion: Studies which examined optimal DAPTduration, displayed controversial results, mainly observed because of the discrepancy and heterogeneity betweendifferent study designs or the decision of a great proportion of investigators to statistically test for non-inferiority.A careful, patient-centered approach, which considers thrombotic risk versus the risk for bleeding complicationsand other individual characteristics and comorbidities, is required when deciding DAPT duration.