Are at least 12 months of dual antiplatelet therapy needed for all patients with drug-eluting stents? Not all patients with drug-eluting stents need at least 12 months of dual antiplatelet therapy.

Abstract

> “Things are not always as simple as they first appear.” > > Phaedrus, 25 ad 1 The optimal duration of dual antiplatelet therapy (DAPT) after coronary arterial stenting is an important question for clinicians and patients alike and represents a dynamic state of benefit and risk to achieve optimal outcomes. Clinicians must carefully balance the risk for future coronary artery–related events with an assessment of bleeding risk and, in many instances, recognize a changing risk-benefit relationship from the time of stent implantation. Patients must work closely with their healthcare providers to understand their medical condition—the basis for and importance of the treatments recommended—and to openly share their values, preferences, and anticipated obstacles to adhering to medical advice, including cost and limited access to ambulatory clinics in the community. The debate over duration of therapy comes at a time when national health care is facing serious challenges, with costs to individual patients contributing to an increasing divide among social classes in the United States and abroad.2 It also presents an opportunity to honor a pragmatic side of precision medicine as a priority for population health and the scientific community.3 Response by Brener on p 2019 To arrive at our position that not all patients undergoing coronary arterial stent implantation require at least 12 months of DAPT, we posed the following questions: What is the goal of DAPT following stent implantation; what is the evidence in favor of either 12 months of DAPT after stent implantation; what are the underlying determinants of benefit and risk for DAPT; what are the most common factors that affect the duration of DAPT in clinical practice; and who are the optimal candidates for <12 months of DAPT? As with other blood-contacting medical devices, thrombosis is the predominant cause of failure after stent implantation. Accordingly, …