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.
Highlights
Coronary revascularization with percutaneous intervention (PCI) is currently the standard of care in the treatment of patients with acute coronary syndrome (ACS), and has become one of the most frequently performed therapeutic procedures in Medicine [1]
The optimal duration of Dual antiplatelet therapy (DAPT) after stent implantation has been a matter of intense debate and has attracted a great deal of scientific attention
The composite primary endpoint of major adverse cardiovascular and cerebrovascular events (MACCE) at 28 months was similar in both groups (6.8% vs. 7.3%, p = 0.22), and there was no significant difference in major bleeding
Summary
Coronary revascularization with percutaneous intervention (PCI) is currently the standard of care in the treatment of patients with acute coronary syndrome (ACS), and has become one of the most frequently performed therapeutic procedures in Medicine [1]. Comprising of aspirin and a P2Y12 inhibitor is one of the most commonly prescribed therapies in cardiovascular medicine. The optimal duration of DAPT after stent implantation has been a matter of intense debate and has attracted a great deal of scientific attention. As we celebrate the various advances in the techniques and technology of transcatheter therapeutics in this 40th year of Interventional. Cardiology, the optimal duration of DAPT continue to be elusive. The following review is aimed at critically evaluating the available evidence to help make crucial clinical decisions regarding duration of DAPT and triple therapy
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