Commentary

Physician Judgment Key to Determine Duration, Intensity of DAPT

Dual antiplatelet therapy is an important part of stenting procedures. The transition from more complex regimens to the dual antiplatelet therapy regimens used today has made stenting a better and safer experience for patients. As well, the landscape has shifted with respect to risk for stent thrombosis due to advances in stent drug and polymer technology.

Recently, a number of new trials have provided additional information on dual antiplatelet therapy (DAPT) duration and intensity. Data have shown that more potent antiplatelet regimens might further reduce risk in patients with a history of ACS and low bleeding risk and that longer-duration DAPT beyond 1 year is likely warranted in patients with ACS who have been stented, and probably even in high-risk ACS patients who have not been stented. The PEGASUS-TIMI 54 trial also lends support to the concept of longer-duration DAPT in patients with prior MI. Many questions remain regarding optimal DAPT duration in patients with second-generation DES who haven’t had an ACS, especially for straightforward cases without bifurcation stents or high procedural complexity. In those patients, the data seem to suggest that DAPT for less than 1 year probably minimizes bleeding risk without exposure to excess stent thrombosis risk, though further studies are ongoing.

Deepak L. Bhatt, MD, MPH

Deepak L. Bhatt

I believe it will be a matter of individualizing care without being overly proscriptive and saying that every patient should receive one particular DAPT strategy. Good physician judgment will be necessary to determine which patients benefit from which intensity of DAPT and for how long.

We are fortunate in this issue of Cardiology Today’s Intervention to have a number of investigators involved with the trials and other experts to provide their opinions on how to interpret this large, complex and growing body of data. We want to know your thoughts. Email the editors at cardiology@healio.com.

Deepak L. Bhatt, MD, MPH

Chief Medical Editor, Cardiology Today’s Intervention

Dual antiplatelet therapy is an important part of stenting procedures. The transition from more complex regimens to the dual antiplatelet therapy regimens used today has made stenting a better and safer experience for patients. As well, the landscape has shifted with respect to risk for stent thrombosis due to advances in stent drug and polymer technology.

Recently, a number of new trials have provided additional information on dual antiplatelet therapy (DAPT) duration and intensity. Data have shown that more potent antiplatelet regimens might further reduce risk in patients with a history of ACS and low bleeding risk and that longer-duration DAPT beyond 1 year is likely warranted in patients with ACS who have been stented, and probably even in high-risk ACS patients who have not been stented. The PEGASUS-TIMI 54 trial also lends support to the concept of longer-duration DAPT in patients with prior MI. Many questions remain regarding optimal DAPT duration in patients with second-generation DES who haven’t had an ACS, especially for straightforward cases without bifurcation stents or high procedural complexity. In those patients, the data seem to suggest that DAPT for less than 1 year probably minimizes bleeding risk without exposure to excess stent thrombosis risk, though further studies are ongoing.

Deepak L. Bhatt, MD, MPH

Deepak L. Bhatt

I believe it will be a matter of individualizing care without being overly proscriptive and saying that every patient should receive one particular DAPT strategy. Good physician judgment will be necessary to determine which patients benefit from which intensity of DAPT and for how long.

We are fortunate in this issue of Cardiology Today’s Intervention to have a number of investigators involved with the trials and other experts to provide their opinions on how to interpret this large, complex and growing body of data. We want to know your thoughts. Email the editors at cardiology@healio.com.

Deepak L. Bhatt, MD, MPH

Chief Medical Editor, Cardiology Today’s Intervention