Optimal duration of dual antiplatelet therapy after coronary stent placement or acute coronary syndrome. Is customisation possible?
Copyright © 2019 Elsevier Masson SAS. All rights reserved..
The recommended 6-month dual antiplatelet therapy (DAPT) after coronary angioplasty with implantation of a drug eluting stent is based on solid evidence, but must take into account continuous improvements in stent technology leading to reduced thrombogenicity. In stable patients with a high hemorrhagic risk, it is possible to reduce DAPT duration at 3 months without significant increase in the risks of ischemic events or stent thrombosis. Further reduction toward a 1-month DAPT is likely to involve new strategies of stopping aspirin at 1 month, and continuing long-term monotherapy with inhibitors of P2Y12 receptor. After acute coronary syndrome, it seems possible to reduce the duration of DAPT (standard, 12 months) in patients at high risk of bleeding. A 6-month DAPT, or even less, provides a good compromise between hemorrhagic risk and ischemic recurrences. Conversely, in patients who have fully tolerated a 12-month DAPT after infarction, and who are at very high risk of ischemic recurrence, the prolongation of a P2Y12 inhibitor in combination with aspirin may be considered, with a risk of haemorrhage almost double. A certain degree of customisation of the duration of DAPT is therefore possible, based on age, renal function, comorbidities, haemorrhagic history, and the use of risk scores (PRECISE-DAPT, DAPT).
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:68 |
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| Enthalten in: |
Annales de cardiologie et d'angeiologie - 68(2019), 5 vom: 01. Nov., Seite 347-357 |
| Sprache: |
Französisch |
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| Weiterer Titel: |
Durée optimale de la double antiagrégation plaquettaire après angioplastie coronaire ou syndrome coronaire aigu. La personnalisation est-elle possible ? |
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| Beteiligte Personen: |
Georges, J L [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 07.04.2020 Date Revised 08.04.2020 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.ancard.2019.07.011 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
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| 245 | 1 | 0 | |a Optimal duration of dual antiplatelet therapy after coronary stent placement or acute coronary syndrome. Is customisation possible? |
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| 520 | |a Copyright © 2019 Elsevier Masson SAS. All rights reserved. | ||
| 520 | |a The recommended 6-month dual antiplatelet therapy (DAPT) after coronary angioplasty with implantation of a drug eluting stent is based on solid evidence, but must take into account continuous improvements in stent technology leading to reduced thrombogenicity. In stable patients with a high hemorrhagic risk, it is possible to reduce DAPT duration at 3 months without significant increase in the risks of ischemic events or stent thrombosis. Further reduction toward a 1-month DAPT is likely to involve new strategies of stopping aspirin at 1 month, and continuing long-term monotherapy with inhibitors of P2Y12 receptor. After acute coronary syndrome, it seems possible to reduce the duration of DAPT (standard, 12 months) in patients at high risk of bleeding. A 6-month DAPT, or even less, provides a good compromise between hemorrhagic risk and ischemic recurrences. Conversely, in patients who have fully tolerated a 12-month DAPT after infarction, and who are at very high risk of ischemic recurrence, the prolongation of a P2Y12 inhibitor in combination with aspirin may be considered, with a risk of haemorrhage almost double. A certain degree of customisation of the duration of DAPT is therefore possible, based on age, renal function, comorbidities, haemorrhagic history, and the use of risk scores (PRECISE-DAPT, DAPT) | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a Acute coronary syndrome | |
| 650 | 4 | |a Angioplastie coronaire | |
| 650 | 4 | |a Angor instable | |
| 650 | 4 | |a Antiplaquettaires | |
| 650 | 4 | |a Antiplatelet therapy | |
| 650 | 4 | |a DAPT | |
| 650 | 4 | |a Double antiagrégation plaquettaire | |
| 650 | 4 | |a Drug eluting stent | |
| 650 | 4 | |a Infarctus | |
| 650 | 4 | |a Myocardial infarction | |
| 650 | 4 | |a Percutaneous coronary intervention | |
| 650 | 4 | |a Stent | |
| 650 | 4 | |a Syndrome coronarien aigu | |
| 650 | 4 | |a Unstable angina | |
| 650 | 7 | |a Platelet Aggregation Inhibitors |2 NLM | |
| 700 | 1 | |a Cherif, G |e verfasserin |4 aut | |
| 700 | 1 | |a Ajlani, B |e verfasserin |4 aut | |
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