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Antiplatelet Therapy in Coronary Artery Disease: A Daunting Dilemma
Surya Chaturvedula1, Daniel Diver2,3, Aseem Vashist4,5,6
1Department of Cardiology, University of Connecticut School of Medicine, Farmington, CT 06030, USA. chaturvedula@uchc.edu.
Insights
Determining the optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) is complex. Evidence guides individualized decisions based on ischemic and bleeding risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Percutaneous coronary intervention (PCI) with stenting is standard for acute coronary syndrome (ACS).
- Dual antiplatelet therapy (DAPT), using aspirin and a P2Y12 inhibitor, follows PCI.
- Optimal DAPT duration is debated due to evolving treatments and patient factors.
Purpose of the Study:
- To critically evaluate evidence on DAPT duration after PCI for ACS.
- To aid clinical decision-making regarding individualized DAPT and triple therapy duration.
Main Methods:
- Review of current scientific literature and clinical guidelines.
- Analysis of factors influencing DAPT duration, including stent type, antiplatelet agents, anticoagulants, and patient comorbidities.
- Assessment of ischemic and bleeding risk stratification.
Main Results:
- Efficacy of DAPT is established, but optimal duration is not universally defined.
- Individualized DAPT duration is recommended, balancing ischemic and bleeding risks.
- Shared decision-making between clinician and patient is encouraged.
Conclusions:
- Clinical decisions on DAPT duration require careful consideration of patient-specific risks.
- Further research may clarify optimal strategies for DAPT and triple therapy in diverse patient populations.
Abstract:
Percutaneous coronary intervention (PCI) with stenting for the treatment of acute coronary syndrome (ACS) is the contemporary standard of care. Such treatment is followed by dual antiplatelet therapy (DAPT) comprising of aspirin and a P2Y12 inhibitor. The efficacy of this therapy has been well established but the optimal duration of DAPT remains elusive, and has thus far attracted a prodigious deal of scientific attention. The decision regarding DAPT duration can be clinically challenging in the modern era with the evolution of newer stents, more potent antiplatelet agents, and novel anticoagulant drugs in addition to an older patient population with multiple comorbidities. Major societal guidelines have emphasized comprehensive assessment of ischemic and bleeding risk, in turn recommending individualization of DAPT duration, thus encouraging "shared decision making". The following review is aimed at critically evaluating the available evidence to help make these crucial clinical decisions regarding duration of DAPT and triple therapy.
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