TY - JOUR
T1 - Optimal Duration of Dual Antiplatelet Therapy after Coronary Stent Implantation
AU - Witberg, Guy
AU - Lev, Eli
AU - Kornowski, Ran
N1 - Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved
PY - 2015/11/15
Y1 - 2015/11/15
N2 - Dual antiplatelet pharmacotherapy reduces ischemic events at the cost of excess bleeding in patients who underwent coronary stenting. The currently recommended treatment period is based on trials held some 20 years ago and not relevant to current clinical practice. In recent years, numerous clinical trials have tried to answer the question of what is the optimal duration of therapy to maximize clinical benefit. These trials showed 2 seemingly conflicting answers - on one hand, shorter treatment duration seems to be safer in reducing bleeding while not increasing ischemic events, and on the other hand, longer duration is superior in terms of preventing ischemic events albeit at the cost of increased bleeding rates. In this review, we summarize the evidence favoring each approach, highlight the limitations of the various pivotal clinical trials in this field, review future directions of research and changes in practice that may influence the duration of antiplatelet therapy, and attempt to propose a personalized approach to achieve maximal benefit for the individual patient.
AB - Dual antiplatelet pharmacotherapy reduces ischemic events at the cost of excess bleeding in patients who underwent coronary stenting. The currently recommended treatment period is based on trials held some 20 years ago and not relevant to current clinical practice. In recent years, numerous clinical trials have tried to answer the question of what is the optimal duration of therapy to maximize clinical benefit. These trials showed 2 seemingly conflicting answers - on one hand, shorter treatment duration seems to be safer in reducing bleeding while not increasing ischemic events, and on the other hand, longer duration is superior in terms of preventing ischemic events albeit at the cost of increased bleeding rates. In this review, we summarize the evidence favoring each approach, highlight the limitations of the various pivotal clinical trials in this field, review future directions of research and changes in practice that may influence the duration of antiplatelet therapy, and attempt to propose a personalized approach to achieve maximal benefit for the individual patient.
UR - http://www.scopus.com/inward/record.url?scp=84945928043&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2015.08.029
DO - 10.1016/j.amjcard.2015.08.029
M3 - Review article
C2 - 26456206
AN - SCOPUS:84945928043
SN - 0002-9149
VL - 116
SP - 1631
EP - 1636
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 10
ER -