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Dual Antiplatelet Therapy After Percutaneous Coronary Intervention.

The optimal duration of aspirin plus a P2Y12 inhibitor for patients undergoing percutaneous coronary intervention (PCI) for stable ischemic heart disease is uncertain and continues to be debated. The benefit of preventing myocardial infarction (MI) and stent thrombosis (ST) is balanced against an increased risk of bleeding when continuing dual antiplatelet therapy (DAPT) beyond 12 months. These findings were demonstrated in the large DAPT study,1 which showed that DAPT (aspirin combined with clopidogrel or prasugrel) beyond 12 months after PCI with drug-eluting stents (DES), significantly reduced the risks of ST and major adverse cardiovascular and cerebrovascular events but was linked to an increased risk of bleeding at 30 months compared with aspirin alone. Finally, rate of death from any cause was 2% in continued DAPT versus 1.5% in placebo (hazard ratio [HR], 1.36; 95% CI, 1.00–1.85; P=0.05). Many have concluded that the risks and benefits that DAPT duration beyond 1 year should be individualized based on patient’s bleeding and ischemic risks.