Optimal duration of dual antiplatelet therapy after PCI: integrating procedural complexity, bleeding risk and the acuteness of clinical presentation

Expert Review of Cardiovascular Therapy
Huazhen ChenGennaro Giustino

Abstract

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor constitutes the standard of care to prevent major adverse cardiac events in patients who undergo percutaneous coronary intervention (PCI) with drug-eluting stents (DES). However, the anti-ischemic benefits of DAPT are counterbalanced by an increased risk of hemorrhagic complications, which are known to be associated with increased morbidity and mortality. While the efficacy of DAPT in patients presenting with acute coronary syndrome (ACS) has been well established, the risk-benefit balance of DAPT in other subsets of patients remain controversial. As a result, multiple risk scores to inform optimal duration of DAPT have been developed recently for individuals with various degrees of coronary artery disease. Areas covered: Authors summarize the current evidence and guideline recommendations on the optimal duration and intensity of DAPT across the spectrum of coronary artery disease including those who undergo complex PCI and recapitulated the recently developed risk scores to inform clinical decision on the optimal duration of DAPT. Expert commentary: Clinical decision-making for upfront duration of DAPT after PCI with DES should consider the individual...Continue Reading

References

Aug 25, 2001·The New England Journal of Medicine·S YusufUNKNOWN Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators
Aug 25, 2001·Lancet·S R MehtaUNKNOWN Clopidogrel in Unstable angina to prevent Recurrent Events trial (CURE) Investigators
Jun 7, 2002·The New England Journal of Medicine·Marie-Claude MoriceUNKNOWN RAVEL Study Group. Randomized Study with the Sirolimus-Coated Bx Velocity Balloon-Expandable Stent in the Treatment of Patie
Jan 16, 2004·The New England Journal of Medicine·Gregg W StoneUNKNOWN TAXUS-IV Investigators
May 5, 2005·JAMA : the Journal of the American Medical Association·Ioannis IakovouAntonio Colombo
Nov 8, 2005·Lancet·Z M ChenUNKNOWN COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group
Jul 4, 2006·Journal of the American College of Cardiology·Michael JonerRenu Virmani
Nov 6, 2007·The New England Journal of Medicine·Stephen D WiviottUNKNOWN TRITON-TIMI 38 Investigators
Apr 18, 2009·Journal of the American College of Cardiology·Jochem W van WerkumJurriën M ten Berg
May 26, 2009·JACC. Cardiovascular Interventions·Edward L HannanSpencer B King
Sep 1, 2009·The New England Journal of Medicine·Lars WallentinMona Thorsén
May 7, 2010·The New England Journal of Medicine·Gregg W StoneUNKNOWN SPIRIT IV Investigators
Jun 18, 2010·The New England Journal of Medicine·Patrick W SerruysStephan Windecker
Aug 21, 2010·Nature Reviews. Cardiology·Usman BaberSamin K Sharma
Oct 16, 2010·Journal of the American College of Cardiology·David R HolmesDavid J Moliterno
Jan 21, 2011·The New England Journal of Medicine·Gregg W StoneUNKNOWN PROSPECT Investigators
Mar 17, 2011·JAMA : the Journal of the American Medical Association·Matthew J PriceUNKNOWN GRAVITAS Investigators
Dec 29, 2011·JAMA : the Journal of the American Medical Association·Michael V HolmesJuan P Casas
Nov 6, 2012·The New England Journal of Medicine·Jean-Philippe ColletUNKNOWN ARCTIC Investigators
Oct 1, 2013·Journal of the American College of Cardiology·Udaya S TantryUNKNOWN Working Group on On-Treatment Platelet Reactivity
Mar 15, 2014·European Heart Journal·Edoardo CamenzindUNKNOWN PROTECT Steering Committee and Investigators
Oct 8, 2014·Nature Reviews. Cardiology·Francesco Franchi, Dominick J Angiolillo
Nov 18, 2014·The New England Journal of Medicine·Laura MauriUNKNOWN DAPT Study Investigators
Dec 24, 2014·Pharmacological Research : the Official Journal of the Italian Pharmacological Society·Anwer Habib, Aloke V Finn
Jan 27, 2015·European Heart Journal·Stefanie Schulz-SchüpkeUNKNOWN Intracoronary Stenting and Antithrombotic Regimen: Safety And EFficacy of 6 Months Dual Antiplatelet Therapy After Drug-Elut
Mar 20, 2015·Journal of the American College of Cardiology·Robert W YehUNKNOWN DAPT Study Investigators
Mar 21, 2015·Journal of the American College of Cardiology·Roxana MehranUsman Baber
Sep 1, 2015·Journal of the American College of Cardiology·Philippe GénéreuxGregg W Stone
Sep 4, 2015·Lancet·Raffaele PiccoloStephan Windecker
Oct 16, 2015·The New England Journal of Medicine·Philip UrbanUNKNOWN LEADERS FREE Investigators
Nov 12, 2015·JAMA : the Journal of the American Medical Association·Sung-Jin HongUNKNOWN IVUS-XPL Investigators
Mar 30, 2016·JAMA : the Journal of the American Medical Association·Robert W YehUNKNOWN DAPT Study Investigators

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