Dual Antiplatelet Therapy: A Concise Review for Clinicians

Abstract

Dual antiplatelet therapy (DAPT) combines two antiplatelet agents to decrease the risk of thrombotic complications associated with atherosclerotic cardiovascular diseases. Emerging data about the duration of DAPT is being published continuously. New approaches are trying to balance the time, benefits, and risks for patients taking DAPT for established cardiovascular diseases. Short-term dual DAPT of 3–6 months, or even 1 month in high-bleeding risk patients, is equivalent in terms of efficacy and effectiveness compared to long-term DAPT for patients who experienced percutaneous coronary intervention in an acute coronary syndrome setting. Prolonged DAPT beyond 12 months reduces stent thrombosis, major adverse cardiovascular events, and myocardial infarction rates but increases bleeding risk. Extended DAPT does not significantly benefit stable coronary artery disease patients in reducing stroke, myocardial infarction, or cardiovascular death. Ticagrelor and aspirin reduce cardiovascular events in stable coronary artery disease with diabetes but carry a higher bleeding risk. Antiplatelet therapy duration in atrial fibrillation patients after percutaneous coronary intervention depends on individual characteristics and bleeding risk. Antiplatelet therapy is crucial for post-coronary artery bypass graft and transcatheter aortic valve implantation; Aspirin (ASA) monotherapy is preferred. Antiplatelet therapy duration in peripheral artery disease depends on the scenario. Adding vorapaxar and cilostazol may benefit secondary prevention and claudication, respectively. Carotid artery disease patients with transient ischemic attack or stroke benefit from antiplatelet therapy and combining ASA and clopidogrel is more effective than ASA alone. The optimal duration of DAPT after carotid artery stenting is uncertain. Resistance to ASA and clopidogrel poses an incremental risk of deleterious cardiovascular events and stroke. The selection and duration of antiplatelet therapy in patients with cardiovascular disease requires careful consideration of both efficacy and safety outcomes. The use of combination therapies may provide added benefits but should be weighed against the risk of bleeding. Further research and clinical trials are needed to optimize antiplatelet treatment in different patient populations and clinical scenarios.

Early detection of resistance to dual antiplatelet therapy in patients who have undergone percutaneous coronary intervention using the VerifyNow test and associated factors

“…The prevalence of antiplatelet drug resistance varied according to various studies. In patients with cardiovascular disease, the rate of laboratory resistance to aspirin ranged from 2-57%, while the range of resistance to clopidogrel was 16-50% ( 24 , 25 ). Resistance to an antiplatelet drug is influenced by several factors including race, ethnicity and geographic region.…”

Role of Vasoactive Hormone-Induced Signal Transduction in Cardiac Hypertrophy and Heart Failure

“…Several antiplatelet agents such as aspirin, clopidogrel and cilostazol, either alone or in combination, have been reported to produce beneficial effects in diverse cardiovascular dis-eases including pulmonary hypertension [157,158], coronary artery abnormalities [159][160][161][162][163] and ventricular arrhythmias and atrial fibrillation [155,156,164]. Furthermore, the 5-HT 2A receptor antagonist, ketanserin, has been shown to improve hemodynamic and neurohumoral alterations in patients with heart failure [165,166].…”

Computational and Experimental Drug Repurposing of FDA-Approved Compounds Targeting the Cannabinoid Receptor CB1

“…Initially formulated by Bayer in 1899 as an analgesic, it underwent repurposing several decades later as an antiplatelet aggregation drug [8,9]. Then, aspirin was proposed to treat other conditions such as cancer [10,11] and cardiovascular diseases [12]. Thalidomide is another example of DR.…”