Dual antiplatelet therapy after coronary stent implantation: Individualizing the optimal duration.

Autor: Lugo LM; Heart Diseases Institute, Bellvitge University Hospital - IDIBELL, University of Barcelona; L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Corazón de Querétaro; Querétaro, México., Ferreiro JL; Heart Diseases Institute, Bellvitge University Hospital - IDIBELL, University of Barcelona; L'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: jlferreiro@bellvitgehospital.cat.
Jazyk: angličtina
Zdroj: Journal of cardiology [J Cardiol] 2018 Aug; Vol. 72 (2), pp. 94-104. Date of Electronic Publication: 2018 Mar 27.
DOI: 10.1016/j.jjcc.2018.03.001
Abstrakt: Dual antiplatelet therapy (DAPT) with a P2Y 12 receptor antagonist in addition to aspirin is the antiplatelet treatment of choice in patients undergoing percutaneous coronary intervention. Despite DAPT being one of the most widely investigated treatment strategies in the cardiology field, its optimal duration after coronary stenting remains controversial. The balance between the possible benefit of preventing a thrombotic event and the risk of suffering a bleeding complication due to maintenance of therapy is of critical relevance to determine the duration of DAPT in a given patient. Indeed, extended DAPT is associated with a reduction in non-fatal ischemic outcomes, at the cost of increasing the risk of bleeding events. Of note, several factors related to the patient, the procedure, or the device implanted may influence the ischemic and/or bleeding risk profiles of a given patient. Therefore, it is reasonable to recommend that the decision on DAPT duration should be individualized on a case-to-case basis. This review aims to provide a comprehensive overview of the current status of knowledge on duration of DAPT after coronary stenting, focusing on the evidence provided mainly by randomized clinical trials, as well as to discuss the factors that may influence the individual ischemic and bleeding risk profiles for a given patient, and whether the use of risk scores may inform the decision-making process for determining DAPT duration.
(Copyright © 2018 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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