Dual antiplatelet therapy following drug-eluting stent implantation: How long is long enough?

Abstract

A period of dual antiplatelet therapy (DAPT) is mandatory after drug-eluting stent (DES) implantation to reduce the risk of stent thrombosis as a consequence of inflammation during the healing process. DAPT is also claimed to be associated with other benefits beyond this, including a reduction in ischemic events and improvements in clinical outcomes. A number of studies have investigated the feasibility of shortened DAPT in a bid to maximize benefits, while reducing adverse events; however, there are recent data to suggest that prolongation of DAPT may be associated with additional benefits at the risk of increased bleeding complications. On the basis of currently available evidence, we believe that all patients should be treated with DAPT for a minimum of 6 months after drug-eluting stent (DES) implantation. However, the decision to prolong therapy beyond this should be made on an individual basis, taking into account the potential benefits against specific risk factors for subsequent adverse events.