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Dual Antiplatelet TherapyIs It Time to Cut the Cord With Aspirin? Impact of myocardial fibrosis on left ventricular remodelling, recovery, and outcome after transcatheter aortic valve implantation in different haemodynamic subtypes of severe aortic stenosis Correlations between fractional flow reserve and intravascular ultrasound in patients with an ambiguous left main coronary artery stenosis Clinical and angiographic outcomes of patients treated with everolimus-eluting stents or first-generation Paclitaxel-eluting stents for unprotected left main disease Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data Differential Impact of Heart Failure With Reduced Ejection Fraction on Men and Women Decline in Left Ventricular Ejection Fraction During Follow-Up in Patients With Severe Aortic Stenosis Complex PCI procedures: challenges for the interventional cardiologist Association of Effective Regurgitation Orifice Area to Left Ventricular End-Diastolic Volume Ratio With Transcatheter Mitral Valve Repair OutcomesA Secondary Analysis of the COAPT Trial
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Editorial2019;321(24):2409-2411.

JOURNAL：JAMA. Article Link

Dual Antiplatelet TherapyIs It Time to Cut the Cord With Aspirin?

KM Ziada; DJ Moliterno et al. Keywords: DAPT; 1-month clopidogrel vs. 12 month aspirin and clopidogrel; clinical outcomes; 3 years

ABSTRACT

Since evidence of increased risk of stent thrombosis with first-generation drug-eluting stents surfaced in 20051,2 and the US Food and Drug Administration advised interventional cardiologists to use dual antiplatelet therapy (DAPT) for 12 months following implantation of drug-eluting stents, the appropriate duration of DAPT has been widely studied and hotly debated. Dual antiplatelet therapy consists of concurrent administration of aspirin and a P2Y12 inhibitor. Determining the duration of DAPT requires a balance between 2 objectives: lowering the risk of ischemic events with more intense and longer antiplatelet therapy vs lowering the risk of bleeding events with less intense and shorter antiplatelet therapy. Because second-generation drug-eluting stents are associated with lower rates of stent thrombosis,3 the argument against longer DAPT was revisited. The updated guidelines incorporated such considerations by recommending a shorter duration of DAPT for selected patients, namely those with stable clinical status in whom risk of ischemic events is low.4,5

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