Optimal duration of dual antiplatelet therapy after acute coronary syndromes and coronary stenting

Alon Eisen, Deepak L. Bhatt

Research output: Contribution to journalReview articlepeer-review

Abstract

DAPT is the cornerstone of treatment in patients after stent implantation and after an ACS. Patients after ACS may have a preferential benefit from longer DAPT duration by reducing the thrombotic milieu in the coronary bed, whether related or unrelated to the stent.92 This differs from PCI in patients with stable CAD, in whom DAPT duration may be shortened, since it is prescribed mainly to reduce the rates of ST, which are already very low in the era of the newer-generation DES, other than in very complex PCI procedures. When deciding about DAPT duration, a clinician should be able to synthesise the sparse medical information and evidence-based data from recent years, be familiar with the current guideline recommendations and most importantly evaluate the patient-specific characteristics, namely ischaemic and bleeding risks. The optimal DAPT duration remains unknown since there are numerous scenarios with different durations of DAPT. Similar to antibiotics in infectious disease, the field will not evolve towards a 'one-size-fits-all' approach, but rather to an individually tailored approach in which DAPT duration should be decided after carefully accounting for patient, procedural and stent-related characteristics.

Original languageEnglish
Pages (from-to)871-884
Number of pages14
JournalHeart
Volume103
Issue number11
DOIs
StatePublished - 1 Jun 2017
Externally publishedYes

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