Causes and clinical implications of premature discontinuation of dual antiplatelet therapy.

PURPOSE OF REVIEW

To address the problem of dual antiplatelet therapy (DAPT) discontinuation in patients undergoing surgery.

RECENT FINDINGS

In about half of patients who suspend DAPT, the reasons for discontinuation are not known. The price to pay for this suspension is a dramatic increase in mortality and major cardiac adverse events, especially after early suspension (<1 month). This issue on when a patient on DAPT should undergo urgent surgery is particularly important. In this regard, the available literature data regarding DAPT continuation versus suspension and the best way to proceed are conflicting. Another important question is whether DAPT suspension has the same safety profile in all stents. Several studies demonstrated that the second-generation drug-eluting stent compared favorably to the first-generation stents in efficacy and safety, and that DAPT discontinuation after 6 months appears less critical in second-generation stents. Finally, there is the possibility that some psychological risk factors might play a considerable role in stent thrombosis after DAPT discontinuation, but the available data are scarce.

SUMMARY

Half of the patients on DAPT discontinue therapy; the earlier the interruption, the higher the risk. Second-generation stents mitigate this scenario. Psychological factors (depression, anxiety, and so on) may reduce patients' compliance and, thereby, increase the risk of cardiovascular events and stent thrombosis.