Longer dual antiplatelet therapy (DAPT) after percutaneous coronary intervention has higher anti-ischaemic efficacy than shorter DAPT but is associated with more frequent bleeding

Commentary on: Spencer FA, Prasad M, Vandvik PO, et al.. Longer- versus shorter-duration dual-antiplatelet therapy after drug-eluting stent placement: a systematic review and meta-analysis. Ann Intern Med 2015;163:118–26. Context Dual antiplatelet therapy (DAPT) with aspirin plus a P2Y12 receptor antagonist is recommended after drug eluting stent implantation (DES) for at least 12 months by the American College of Cardiology/American Heart Association1 and for 6–12 months by European guidelines. Recent randomised controlled trials (RCT) suggested comparable efficacy of short-term DAPT versus therapy of at least 12 months, raising the question of whether prolonged DAPT offers clinical benefit. However, concerns about DES have arisen regarding the propensity for thrombotic events occurring more than 1 year after stent implantation.2 One RCT showed a significant reduction of stent thrombosis with DAPT beyond 12 months at the price of increased bleeding.3 The 12-month cut-off is however based mainly on observational data...

Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Navarese, E. P. Tags: Journalology, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Radiology, Clinical diagnostic tests, Ethics Therapeutics/Prevention Source Type: research