The Pros and Cons of Dual Antiplatelet Therapy

Three recent reports add to our understanding of the tradeoffs between dual antiplatelet therapy and aspirin alone.

One trial — the industry-supported, placebo-controlled DAPT study — involved nearly 10,000 patients who had received drug-eluting coronary stents. Patients were randomized to receive dual antiplatelet therapy with aspirin plus a thienopyridine (clopidogrel or prasugrel [Effient]) for either 12 or 30 months. During the 18-month exposure to dual therapy versus aspirin alone, the dual-therapy group experienced significantly lower incidences of stent thrombosis (0.4% vs. 1.4%) and major adverse cardiovascular events (4.3% vs. 5.9%). However, moderate-to-severe bleeding occurred significantly more often in the dual-therapy group (2.…