Duration of Dual Antiplatelet Therapy After Coronary Stenting

作者：Siasos Gerasimos; Mourouzis Konstantinos; Oikonomou Evangelos; Vavuranakis Manolis; Vogiatzi Georgia; Briasoulis Alexandros; Papageorgiou Nikolaos; Papaioannou Theodore G; Zografos Thodoris; Papapanagiotou Angeliki; Papavassiliou Athanasios G; Stefanadis Christodoulos; Tousoulis Dimitris

来源：Current Pharmaceutical Design, 2016, 22(29): 4583-4595.

DOI：10.2174/1381612822666160720144139

• Antiplatelet treatment
• cardiovascular diseases
• clopidogrel
• coronary artery disease
• percutaneous coronary intervention

Background: Dual antiplatelet therapy (DAPT) is one of the cornerstones of coronary artery disease (CAD) treatment. Standard DAPT requires one of, P2Y12 receptor inhibitors, clopidogrel, prasugrel or ticagrelor as an adjunct therapy to aspirin administration. The decision over DAPT duration depends on the evaluation of thrombotic risk and the assessment of the probability for major bleeding events. Methods: The goal of this work was to identify which would be the appropriate combination of antiplatelet agents and the optimal duration of DAPT, based on the patient's medical history and clinical characteristics. A thorough search of PubMed and the Cochrane Database was conducted in order to identify randomized controlled trials, observational studies, current ESC and ACC/AHA guidelines and novel articles on the subject. Results: The decision over DAPT duration is based on a careful approach which requires the evaluation of thrombotic risk and the assessment of the probability for major bleeding events. A series of aspects and special conditions may influence the duration of DAPT after stenting e.g. the type of the implanted stent (DES or BMS) or if the commencement of DAPT is administered in the context of an acute coronary syndrome or in the setting of stable CAD. Current guidelines can assist clinicians in making decisions but treating patients in special groups e.g. with diabetes mellitus or the elderly people can be very demanding. Conclusion: Studies which examined optimal DAPT duration, displayed controversial results, mainly observed because of the discrepancy and heterogeneity between different study designs or the decision of a great proportion of investigators to statistically test for non-inferiority. A careful, patient-centered approach, which considers thrombotic risk versus the risk for bleeding complications and other individual characteristics and comorbidities, is required when deciding DAPT duration.

• 出版日期2016
• 单位MIT