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Clinical and angiographic outcomes of patients treated with everolimus-eluting stents or first-generation Paclitaxel-eluting stents for unprotected left main disease Management of Asymptomatic Severe Aortic Stenosis: Evolving Concepts in Timing of Valve Replacement Transcatheter Aortic Valve Replacement in Patients With Multivalvular Heart Disease Glycemic Index, Glycemic Load, and Cardiovascular Disease and Mortality Cardiac surgery following transcatheter aortic valve replacement Determinants and Impact of Heart Failure Readmission Following Transcatheter Aortic Valve Replacement Long-Term All-Cause and Cause-Specific Mortality in Asymptomatic Patients With CAC ≥1,000: Results From the CAC Consortium The sinus venosus contributes to coronary vasculature through VEGFC-stimulated angiogenesis Intravascular ultrasound-guided unprotected left main coronary artery stenting in the elderly 2019 AHA/ACC Clinical Performance and Quality Measures for Adults With High Blood Pressure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures

Review Article2017 Aug 29.[Epub ahead of print]

JOURNAL:Drugs. Article Link

Dual Antiplatelet Therapy Duration: Reconciling the Inconsistencies

Costa F, Windecker S, Valgimigli M. Keywords: dual antiplatelet therapy duration; recurrent ischemic events; bleeding events; stent thrombosis

ABSTRACT

Dual antiplatelet therapy (DAPT) prevents recurrent ischemic events after an acute coronary syndrome (ACS) as well as stent thrombosis (ST) in patients with prior stent implantation. Nevertheless, these benefits are counterbalanced by a significant bleeding hazard, which is directly related to the treatment duration. Although DAPT has been extensively studied in numerous clinical trials, optimal treatment duration is still debated, mostly because of apparent inconsistencies among studies. Shortened treatment duration of 6 or 3 months was shown to mitigate bleeding risk compared with consensus-grounded 12-month standard duration, without any apparent excess of ischemic events. However, recent trials showed that a >12-month course of treatment reduces ischemic events but increases bleeding compared with 12 months. The inconsistent benefit of a longer DAPT course compared with shorter treatment durations is puzzling, and requires a careful appraisal of between-studies differences. We sought to summarize the existing evidence aiming at reconciling apparent inconsistencies among these studies, as well as thoroughly discuss the possible increased risk of fatal events associated with long-term DAPT. Benefits and risks of prolonging or shortening DAPT duration will be discussed, with a focus on treatment individualization. Finally, we will provide an outlook for possible future directions in the field.