Dual antiplatelet therapy: More the better?

Dual antiplatelet therapy with aspirin and a thienopyridine (clopidogrel, prasugrel etc) is currently recommended for at least 12 months after implantation of a drug eluting stent (DES) following a percutaneous coronary intervention (PCI). But there have been instances of late stent thrombosis and very late stent thrombosis after DES implantation. Hence the DAPT study (Dual Antiplatelet Therapy) sponsored by the Harvard Clinical Research Institute sought to look at benefits of dual antiplatelet study at 30 months after implantation of a drug eluting stent and bare metal stent. The study results were presented at the American Heart Association meeting 2014. The study enrolled patients 72 hours after stent placement and were given dual antiplatelet agents for 12 months. Those without a bleeding or ischemic complication at 12 months were randomized to receive either dual antiplatelet (DAPT) agents or a matching placebo for the next 18 months. In the DES PCI group there were around ten thousand patients with half each randomized to either dual antiplatelet agents or placebo. About one third of them were diabetics and a quarter were smokers. ST elevation myocardial infarction was present in only one tenth of the patients enrolled, while one third had non ST elevation acute coronary syndrome and a little over one third had stable angina. Major adverse cardiac and cerebrovascular events (MACCE) was significantly lower in the DAPT arm compared to placebo. Myocardial infarctions and ...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs