Dual antiplatelet therapy duration: what are the drivers?

PURPOSE OF REVIEW

To address the evidence, or lack thereof, of dual antiplatelet therapy (DAPT) duration in the percutaneous coronary intervention (PCI) setting.

RECENT FINDINGS

The most recent guidelines on DAPT in the PCI setting are rather discordant about the duration of therapy and refer to results of studies which are often controversial. We extracted the common messages shared from guidelines, and evaluated the most recent studies on DAPT duration. The European guidelines recommend a DAPT duration post-PCI of 1 month after bare metal stent (BMS) implantation in stable angina, 6-12 months after drug-eluting stent (DES) implantation in all patients and 1 year after acute coronary syndrome (ACS), irrespective of the type of implanted stent. In the 2011 ACS American guidelines the duration is not based on the type of stent (BMS or DES), and the need for 12 months DAPT duration is indicated in all cases. In recent studies, the first-generation DES are associated with an increased risk of late and very late stent thrombosis, but optimized procedural techniques may reduce stent thrombosis. Finally, new-generation DES appear to be associated with fewer incidents of late and very late stent thrombosis, compared with first-generation DES.

SUMMARY

The current guidelines provide discordant indications, and are more focused on device type than on patients' clinical characteristics. The benefit of prolonged DAPT is not clearly demonstrated.