Toward Brief Dual Antiplatelet Therapy and P2Y12 Inhibitors for Monotherapy After PCI

Am J Cardiovasc Drugs. 2021 Mar;21(2):153-163. doi: 10.1007/s40256-020-00430-0.

Abstract

The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention remains a controversial topic. The European Society of Cardiology and the American College of Cardiology/American Heart Association recommend at least 6 and 12 months of DAPT after PCI in patients with stable coronary artery disease or acute coronary syndrome, respectively. Although prolonging DAPT duration reduces ischemic events, it is associated with higher rates of bleeding and possible fatal outcomes. The DAPT score can be an important tool to identify patients who may still benefit from prolonged therapy. Nevertheless, several recent randomized controlled trials showed that shortening DAPT duration from 12 to 1-3 months reduces bleeding rates without significantly increasing ischemic event rates. These trials also suggested replacing acetylsalicylic acid (aspirin) with P2Y12 inhibitors after short-term DAPT. We review and compare past and present studies regarding DAPT and analyze the evidence favoring a short DAPT duration and the long-term single antiplatelet agent of choice.

Publication types

  • Review

MeSH terms

  • Aspirin / administration & dosage
  • Aspirin / adverse effects
  • Aspirin / therapeutic use*
  • Drug Administration Schedule
  • Dual Anti-Platelet Therapy / adverse effects
  • Dual Anti-Platelet Therapy / methods*
  • Hemorrhage / chemically induced
  • Humans
  • Percutaneous Coronary Intervention / methods*
  • Platelet Aggregation Inhibitors / pharmacology
  • Platelet Aggregation Inhibitors / therapeutic use
  • Purinergic P2Y Receptor Antagonists / administration & dosage
  • Purinergic P2Y Receptor Antagonists / adverse effects
  • Purinergic P2Y Receptor Antagonists / therapeutic use*
  • Randomized Controlled Trials as Topic
  • Stents / adverse effects

Substances

  • Platelet Aggregation Inhibitors
  • Purinergic P2Y Receptor Antagonists
  • Aspirin