Should We Shorten the Duration of Dual Antiplatelet Therapy After Drug-Eluting Stent Implant?

Data from a large randomized clinical trial of a novel ticagrelor-based strategy suggest no.

Dual antiplatelet therapy (DAPT) limits ischemic complications after percutaneous coronary intervention (PCI) with a drug-eluting stent. Although the optimal duration of DAPT remains debatable, international guidelines currently recommend 6 to 12 months of DAPT (followed by aspirin monotherapy) after PCI for stable coronary artery disease (CAD) — and at least 12 months after PCI for an acute coronary syndrome (ACS). Although longer DAPT durations further limit ischemic events, that benefit is counterbalanced by greater bleeding risk. Some cardiologists speculate that eliminating the aspirin might “decouple” the anti-ischemic benefit from the bleeding risk, thereby optimizing patient outcomes.

In an industry-funded, open-label study, investig…

Reviewing Author

David J. Cohen, MD, MSc

Disclosures

Consultant/Advisory BoardMedtronic; Edwards Lifesciences; Abbott Vascular; Boston Scientific; St. Francis Hospital

Speaker’s BureauBoston Scientific; ZOLL Medical

Grant/Research SupportEdwards Lifesciences; Abbott Vascular; Boston Scientific; Corvia Medical; National Heart, Lung, and Blood Institute; Phillips, Inc.; St. Paul’s Hospital; V-Wave, Inc; ZOLL Medical; CathWorks, ANCORA

Editorial BoardsJACC; American Heart Journal; EuroIntervention; JSCAI; Structural Heart Journal

Leadership Positions in Professional SocietiesSociety of Thoracic Surgeons/American College of Cardiology TVT Registry (Co-Chair, Risk Model Development Committee); Cardiovascular Research Foundation (Co-Director, TCT Annual Meeting; Co-Director, New York Valves Annual Meeting)