Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents

Area of Science:

• Cardiology
• Vascular Medicine
• Pharmacology

Background:

• Dual antiplatelet therapy (DAPT) is standard after coronary stenting to prevent clots.
• Long-term benefits and risks of DAPT beyond one year remain unclear.

Purpose of the Study:

• To evaluate the efficacy and safety of extending DAPT for 18 months after initial 12-month treatment post-drug-eluting stent placement.
• To compare continued thienopyridine and aspirin therapy versus aspirin alone.

Main Methods:

• 10,000 patients receiving drug-eluting stents were randomized after 12 months of DAPT.
• Patients received either continued thienopyridine (clopidogrel/prasugrel) plus aspirin or aspirin alone for an additional 18 months.
• Primary endpoints included stent thrombosis, major adverse cardiovascular/cerebrovascular events, and bleeding.

Main Results:

• Extended DAPT significantly reduced stent thrombosis (0.4% vs 1.4%) and major adverse events (4.3% vs 5.9%).
• Myocardial infarction rates were lower with extended DAPT (2.1% vs 4.1%).
• Moderate/severe bleeding increased with extended DAPT (2.5% vs 1.6%), and all-cause mortality showed a trend towards increase (2.0% vs 1.5%).

Conclusions:

• Extending DAPT beyond one year after drug-eluting stent placement reduces thrombotic events but increases bleeding risk.
• Discontinuation of thienopyridine therapy was associated with a transient increase in stent thrombosis and myocardial infarction risk.