Dual antiplatelet therapy after coronary stenting

Area of Science:

• Cardiology
• Pharmacotherapy
• Interventional Cardiology

Background:

• Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is standard for coronary stenting.
• Clopidogrel, prasugrel, and ticagrelor are approved P2Y12 inhibitors; prasugrel and ticagrelor are preferred for acute coronary syndromes.
• Newer drug-eluting stents (DES) have improved safety profiles, prompting re-evaluation of DAPT duration.

Purpose of the Study:

• To discuss recent updates on DAPT duration guidelines from US and European professional societies.
• To analyze the evidence from clinical trials, registries, and meta-analyses that inform these guideline changes.

Main Methods:

• Review of recent practice guideline updates on DAPT duration.
• Analysis of randomized clinical trials, registries, and meta-analyses informing these guidelines.

Main Results:

• Newer generation DES facilitate shorter DAPT durations, as supported by current guidelines.
• Optimal DAPT duration is individualized based on patient-specific ischemic and bleeding risk profiles.

Conclusions:

• Shorter DAPT durations are now feasible and endorsed with newer DES.
• Individualized DAPT duration, balancing ischemic and bleeding risks, is crucial for optimal patient management.