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Duration of Dual Antiplatelet Therapy in Coronary Artery Disease: a Review Article
Alex D Moseley1, Fareed M Collado1, Annabelle Santos Volgman1
1Rush University Medical Center, 1653 W Congress Parkway, Chicago, IL, 60612, USA.
Insights
Dual antiplatelet therapy (DAPT) after heart events or stenting prevents clots but increases bleeding. Individualizing DAPT duration balances benefits against risks, especially for high-risk patients.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- Dual antiplatelet therapy (DAPT) is standard after acute coronary syndromes (ACS) or coronary stenting.
- Current guidelines recommend DAPT for at least 12 months.
- DAPT offers superior prevention of atherothrombotic events compared to aspirin alone but increases bleeding risk.
Purpose of the Study:
- To evaluate the efficacy and safety of varying DAPT durations.
- To determine optimal DAPT duration balancing ischemic event prevention and bleeding risk.
- To inform individualized treatment strategies for DAPT.
Main Methods:
- Review of recent randomized clinical trials on DAPT duration.
- Analysis of data comparing DAPT durations (e.g., <12 months, 12 months, >12 months).
- Assessment of outcomes including ischemic events (MI, stroke) and bleeding events.
Main Results:
- Extended DAPT (up to 30+ months) reduces ischemic events, particularly in post-MI patients.
- Prolonged DAPT is associated with a significant increase in bleeding risk.
- Trials with DAPT durations less than 12 months show mixed safety and efficacy.
Conclusions:
- Individualizing DAPT duration is crucial to balance cardiovascular benefits against bleeding risks.
- Patients with high ischemic risk and low bleeding risk may benefit from prolonged DAPT beyond 12 months.
- Personalized DAPT strategies are needed to optimize patient outcomes.
Abstract:
Dual antiplatelet therapy (DAPT) following an acute coronary syndrome or after placement of a coronary artery stent is superior to aspirin alone for prevention of atherothrombotic events but carries an increased bleeding risk. DAPT should be continued for at least 12 months based on current guidelines. Recent randomized trials demonstrate reduced ischemic events including myocardial infarction (MI), stroke, and death with continued DAPT for up to 30 months or longer, particularly in the post-MI population. However, this clinical benefit is accompanied by an increased risk of bleeding. Additional trials show mixed safety and efficacy with duration of DAPT of less than 12 months. The current data emphasizes the need to individualize DAPT duration at the patient level to balance the clinical benefits of a reduced risk of cardiovascular ischemic events with the greater risk of clinically significant bleeding. Patients at an increased risk of ischemic events and a lower risk of bleeding should be strongly considered for prolonged DAPT beyond the 1 year currently recommended in the practice guidelines.
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