Dual Antiplatelet Therapy: A Concise Review for Clinicians

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Dual antiplatelet therapy (DAPT) is vital for managing atherosclerotic cardiovascular diseases.
• Emerging research continuously refines optimal DAPT duration, balancing efficacy and bleeding risks.
• Personalized approaches are crucial for tailoring DAPT to individual patient profiles.

Purpose of the Study:

• To review current evidence on DAPT duration in various cardiovascular conditions.
• To analyze the benefits and risks associated with different DAPT durations.
• To guide clinical decision-making for antiplatelet therapy selection and duration.

Main Methods:

• Systematic review of recent clinical trials and guidelines.
• Analysis of data on DAPT efficacy and safety outcomes.
• Evaluation of DAPT in specific patient populations (e.g., acute coronary syndrome, stable coronary artery disease, atrial fibrillation, post-procedural settings).

Main Results:

• Short-term DAPT (1-6 months) is effective post-percutaneous coronary intervention in acute coronary syndrome.
• Prolonged DAPT (beyond 12 months) reduces thrombotic events but increases bleeding risk.
• Extended DAPT offers limited benefit in stable coronary artery disease; specific agents like ticagrelor/aspirin show mixed results with increased bleeding.
• DAPT duration varies significantly based on clinical scenario, patient risk factors, and specific interventions (e.g., PCI, CABG, TAVI, PAD, carotid disease).

Conclusions:

• The optimal duration of DAPT requires careful consideration of individual patient characteristics, bleeding risk, and specific clinical context.
• Combination antiplatelet therapies may offer benefits but necessitate a thorough risk-benefit assessment.
• Further research is needed to optimize antiplatelet strategies across diverse patient populations and clinical scenarios.