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Dual antiplatelet therapy after percutaneous coronary intervention: Personalize the duration

Travis M Howard1, Umesh N Khot2

  • 1Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH.

Cleveland Clinic Journal of Medicine
|June 3, 2021
PubMed

Insights

Dual antiplatelet therapy (DAPT) duration after drug-eluting stent placement is now personalized. Shorter durations are favored due to newer stents and bleeding risks, but some high-risk patients may need longer treatment.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Dual antiplatelet therapy (DAPT) is standard after drug-eluting stent (DES) placement.
  • Historically, 1 year of DAPT was recommended for all patients.
  • Evolving stent technology and understanding of bleeding risks necessitate re-evaluation of DAPT duration.

Purpose of the Study:

  • To review the current recommendations for DAPT duration post-percutaneous coronary intervention (PCI) with DES.
  • To discuss the shift towards personalized DAPT strategies.
  • To highlight factors influencing decisions on DAPT duration.

Main Methods:

  • Review of current clinical guidelines and landmark trials.
  • Analysis of trends in stent thrombosis and bleeding complications.
  • Evaluation of patient-specific risk stratification for ischemic and bleeding events.

Main Results:

  • The trend is towards shorter DAPT durations.
  • Newer DES show lower rates of late and very late stent thrombosis.
  • Patient-specific risk assessment is crucial for tailoring DAPT duration.

Conclusions:

  • DAPT duration is increasingly individualized based on patient risk profiles.
  • Shorter DAPT may be sufficient for many patients due to improved stent safety.
  • Extended DAPT may benefit select high-ischemic risk, low-bleeding risk patients.

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