Is There an Optimal Duration of Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation?

*Bernard Cheung,1-3 Yue Fei,1 Man-Fung Tsoi,1 Tommy Tsang Cheung1

1. Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
2. State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong
3. Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Pokfulam, Hong Kong
*Correspondence to mycheung@hku.hk

Disclosure: The authors have declared no conflicts of interest.
Received: 06.01.17 Accepted: 28.03.17
Citation: EMJ Int Cardiol. 2017;5[1]:71-79.

Abstract

Early discontinuation of dual antiplatelet therapy (DAPT) has been identified as a risk factor for late stent thrombosis after the implantation of drug-eluting stents (DES). Different durations of DAPT have been evaluated in observational studies and randomised controlled trials, but the results on the risk of ischaemic and bleeding events have been variable and controversial. Although extended DAPT shows an ischaemic benefit, it is associated with increased bleeding risk, while short-term DAPT has been suggested to be safe in recent trials with the newer generation of DES. Uncertainty regarding the optimal duration of DAPT makes clinical decisions challenging. In this review, evidence from the latest clinical trials on the duration of DAPT after DES implantation and the factors that affect DAPT duration is examined to find the optimal balance between thrombotic and bleeding risks, which would be a useful guide to clinical practice.

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