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

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.

Performance of HAS-BLED, ORBIT, PRECISE-DAPT, and PARIS risk score for predicting long-term bleeding events in patients taking an oral anticoagulant undergoing percutaneous coronary intervention

“…In the present study, major, minor, and bleeding requiring medical attention were evaluated as the primary endpoint. Various studies have suggested the clinical importance of minor bleeding [26]. Genereux et al reported that not only major but minor bleeding events had a clinical impact on 2-year mortality of postdischarge after PCI [27].…”

Bleeding and ischemic events during dual antiplatelet therapy after second-generation drug-eluting stent implantation in hemodialysis patients

“…Due to multicollinearity, we did not include CKD in baseline characteristics of Table 1. The median DAPT duration was 12 months (IQR, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. DAPT was prescribed in over 80% of all patients.…”

“…To date, there has been no consensus on the optimal DAPT duration, although the importance of balancing the risks and benefits of prescribing DAPT after 2nd-DES implantation has been recognized. Therefore, it is imperative to optimize DAPT duration to patients' characteristics [7][8][9][10][11].…”