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DAPT Duration

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Adjunctive Cilostazol to Dual Antiplatelet Therapy to Enhance Mobilization of Endothelial Progenitor Cell in Patients with Acute Myocardial Infarction: A Randomized, Placebo-Controlled EPISODE Trial Long-term dual antiplatelet-induced intestinal injury resulting in translocation of intestinal bacteria into blood circulation increased the incidence of adverse events after PCI in patients with coronary artery disease Polymer-based or Polymer-free Stents in Patients at High Bleeding Risk ISAR-SAFE: a randomized, double-blind, placebo-controlled trial of 6 vs. 12 months of clopidogrel therapy after drug-eluting stenting 6-Month Versus 12-Month Dual-Antiplatelet Therapy Following Long Everolimus-Eluting Stent Implantation: The IVUS-XPL Randomized Clinical Trial Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk Prasugrel versus clopidogrel in patients with acute coronary syndromes Patient-tailored antithrombotic therapy following percutaneous coronary intervention Management of Antithrombotic Therapy in Atrial Fibrillation Patients Undergoing PCI: JACC State-of-the-Art Review Individualized antiplatelet therapy after drug-eluting stent deployment: Implication of clinical trials of different durations of dual antiplatelet therapy
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Editorial2019;321(24):2409-2411.

JOURNAL：JAMA. Article Link

Dual Antiplatelet TherapyIs It Time to Cut the Cord With Aspirin?

KM Ziada; DJ Moliterno et al. Keywords: DAPT; 1-month clopidogrel vs. 12 month aspirin and clopidogrel; clinical outcomes; 3 years

ABSTRACT

Since evidence of increased risk of stent thrombosis with first-generation drug-eluting stents surfaced in 20051,2 and the US Food and Drug Administration advised interventional cardiologists to use dual antiplatelet therapy (DAPT) for 12 months following implantation of drug-eluting stents, the appropriate duration of DAPT has been widely studied and hotly debated. Dual antiplatelet therapy consists of concurrent administration of aspirin and a P2Y12 inhibitor. Determining the duration of DAPT requires a balance between 2 objectives: lowering the risk of ischemic events with more intense and longer antiplatelet therapy vs lowering the risk of bleeding events with less intense and shorter antiplatelet therapy. Because second-generation drug-eluting stents are associated with lower rates of stent thrombosis,3 the argument against longer DAPT was revisited. The updated guidelines incorporated such considerations by recommending a shorter duration of DAPT for selected patients, namely those with stable clinical status in whom risk of ischemic events is low.4,5

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