Patients' conditions can be complex. Managing DAPT should not be.
While there are many benefits of dual antiplatelet therapy (DAPT), there are also side effects and problems with patient compliance, which can lead to even more complications. About 1 in 5 patients are at risk of bleeding, and this makes a simple one-treatment-fits-all very challenging.1
Striking the DAPT balance: How much is safe?
Long-term DAPT has been shown to increase bleeding and mortality risks, which is a greater concern for non-compliant patients or those at greater risk of bleeding.2
Furthermore, a recent study showed that 1 in 5 patients failed to maintain their DAPT regimen within 30 days of coronary stent implantation.3 Early discontinuation, as demonstrated in the EDUCATE registry, may result in blood clots and heart attacks.4 Finding the right DAPT balance is critical to reducing complications. An individualized approach is even more important than ever.
Early discontinuation may result in heart attacks, blood clots and major bleeding.4
Patients who may benefit from short, 1-month DAPT:5,6
- Urban P, Meredith I, Abizaid A, et al. Polymer-free Drug-Coated Coronary Stents in Patients at High Bleeding Risk. New England Journal of Medicine. 2015;373:2038-47. doi: 10.1056/NEJMoa1503943
- Généreux P, Giustino G, Witzenbichler B, et al. Incidence, Predictors, and Impact of Post-Discharge Bleeding After Percutaneous Coronary Intervention. JACC Cardiovasc Interv. 2015;66:1036-45. doi: 10.1016/j.jacc.2015.06.1323 Palmerini et al. JACC 2015; 65:1092-102.
- Thim T, Johansen M, Chisholm G, et al. Clopidogrel discontinuation within the fi rst year after coronary drug-eluting stent implantation: an observational study. BMC Cardiovasc Disord. 2014;14:100. doi: 10.1186/1471-2261-14-100Thim et al. BMC Cardiovasc Disord. 2014; 14:100.
- Cutlip D, Dauerman H, et al. Thrombotic Complications Associated With Early and Late Nonadherence to Dual Antiplatelet Therapy. JACC: Cardiovascular Interventions. 2015; 8:404-10. doi:10.1016/j.jcin.2014.10.017
- Levine G, Bates E, Bittl J, et al. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients with Coronary Artery Disease. Circulation. 2016;134(10):e123-55. doi: 10.1161/CIR.0000000000000404
- Urban P, Mehran R, Colleran R, et al. European Heart Journal. Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk. European Heart Journal. 2019; 40(31): 2632-2653