The ideal duration of antiplatelet therapy following percutaneous coronary intervention is a topic of much discussion within the cardiology community. Numerous contemporary studies have highlighted benefits of both shortened and prolonged treatment courses within particular patient cohorts. Despite this, there is a delay in seeing such individualised decisions being made within stretched healthcare systems. We aimed to highlight this issue and facilitate discussions on how we can bring this important research from ‘bench’ to ‘bedside’.
The duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is a constantly evolving field. Trials have demonstrated non-inferiority for early de-escalation of DAPT therapy (Feres et al, 2013; Kim et al, 2020) with reduced bleeding, conversely, studies examining extended therapy have shown reduced major adverse cardiovascular events (MACE), and have thus generated much interest within the cardiology community (Bonaca et al, 2015; Mauri et al, 2014). It is evident that a personalised approach to antiplatelet choice and duration can improve patient outcomes.
Scoring systems, such as the DAPT score, have been developed to aid clinicians in risk stratification post PCI, and subsequently in DAPT duration decisions al, 2020). A recent meta-analysis demonstrated that a DAPT score >2 was associated with a higher risk of MACE; with an extended course of treatment (18-24 months) being associated with reduced risk in this cohort when compared to a 12-month duration (Witberg et al, 2020).
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