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The management of secondary mitral regurgitation in patients with heart failure: a joint position statement from the Heart Failure Association (HFA), European Association of Cardiovascular Imaging (EACVI), European Heart Rhythm Association (EHRA), and European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC Rivaroxaban for Thromboprophylaxis in High-Risk Ambulatory Patients With Cancer Impact of Transcatheter Mitral Valve Repair on Preprocedural and Postprocedural Hospitalization Rates Prospective Evaluation of Transseptal TMVR for Failed Surgical Bioprostheses: MITRAL Trial Valve-in-Valve Arm 1-Year Outcomes Implications of the local hemodynamic forces on the formation and destabilization of neoatherosclerotic lesions Strain-Guided Management of Potentially Cardiotoxic Cancer Therapy Risk of Cardiovascular Diseases Among Older Breast Cancer Survivors in the United States: A Matched Cohort Study Ablation Versus Drug Therapy for Atrial Fibrillation in Heart Failure Results From the CABANA Trial Long-Term Outcomes of Patients With Mediastinal Radiation–Associated Coronary Artery Disease Undergoing Coronary Revascularization With Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting Cardio-oncology: A Focus on Cardiotoxicity
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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.
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