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Long-term safety and effectiveness of unprotected left main coronary stenting with drug-eluting stents compared with bare-metal stents Outcomes of patients with and without baseline lipid-lowering therapy undergoing revascularization for left main coronary artery disease: analysis from the EXCEL trial Predictors of Left Main Coronary Artery Disease in the ISCHEMIA Trial Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data Two-year outcomes of everolimus vs. paclitaxel-eluting stent for the treatment of unprotected left main lesions: a propensity score matching comparison of patients included in the French Left Main Taxus (FLM Taxus) and the LEft MAin Xience (LEMAX) registries Left Main Bifurcation Angioplasty: Are 2 Stents One Too Many? Left main coronary artery disease: importance, diagnosis, assessment, and management
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Review Article2017 Dec;70(6):511-517

JOURNAL：J Cardiol. Article Link

Individualized antiplatelet therapy after drug-eluting stent deployment: Implication of clinical trials of different durations of dual antiplatelet therapy

Nakamura M, Kougame N, Iijima R et al. Keywords: Bleeding complication; Drug-eluting stent; Dual antiplatelet therapy; Ischemic event

ABSTRACT

At present, there is consensus that prolonged dual antiplatelet therapy (DAPT) is effective to reduce cardiovascular events at the expense of bleeding complication events. A causal relationship of prolonged DAPT with an increase in mortality remains debatable, however, it appears to be obvious that bleeding complications are associated with an increase in cardiac events. Thus, individualized optimal DAPT duration balancing the risk and benefit of DAPT should be applied. In addition, strategy to minimize bleeding complications is highly recommended. Several risk scores have been reported to discriminate the risk and benefits of DAPT. However, in general, bleeding risk and event risk are correlated with each other, thus predictability of these scores is limited to moderate. Therefore, interpretation of previous trials is important to overcome the shortcome in outcomes. In this review, we provide an overview of DAPT trials and clarify the shortfalls to consider in Japan. Finally, possible future trends with reference to the results of recent clinical trials will be presented.


Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

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