The Past, Present, and Future of Dual-Antiplatelet Therapy Duration in Percutaneous Coronary Intervention
Authors: J. Dawn Abbott
Journal: Annals of Internal Medicine (2017)

Editorials4 July 2017The Past, Present, and Future of Dual-Antiplatelet Therapy Duration in Percutaneous Coronary InterventionJ. Dawn Abbott, MDJ. Dawn Abbott, MDFrom Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-1211 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Dual-antiplatelet therapy (DAPT) in percutaneous coronary intervention (PCI) dates back 20 years and was paramount to the adoption of stents. In 1998, the Stent Anticoagulation Restenosis Study established that the combination of aspirin and a thienopyridine for 4 weeks resulted in a significantly lower rate of bare-metal stent thrombosis than aspirin alone or combined with warfarin (1). One month of DAPT was established as the treatment duration for PCI. In 2001, 3 to 12 months of DAPT was shown to reduce atherothrombotic events but increase major bleeding in patients with acute coronary syndromes (2). An onslaught of studies of optimal ...References1. Leon MB, Baim DS, Popma JJ, Gordon PC, Cutlip DE, Ho KK, et al. A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators. N Engl J Med. 1998;339:1665-71. [PMID: 9834303] CrossrefMedlineGoogle Scholar2. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK; Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345:494-502. [PMID: 11519503] CrossrefMedlineGoogle Scholar3. Laskey WK, Yancy CW, Maisel WH. 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[PMID: 25681754] doi:10.1016/j.jacc.2015.01.039 CrossrefMedlineGoogle Scholar6. Yeh RW, Secemsky EA, Kereiakes DJ, Normand SL, Gershlick AH, Cohen DJ, et al; DAPT Study Investigators. Development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention. JAMA. 2016;315:1735-49. [PMID: 27022822] doi:10.1001/jama.2016.3775 CrossrefMedlineGoogle Scholar7. Piccolo R, Gargiulo G, Franzone A, Santucci A, Ariotti S, Baldo A, et al. Use of the dual-antiplatelet therapy score to guide treatment duration after percutaneous coronary intervention. Ann Intern Med. 2017;167:17-25. doi:10.7326/M16-2389 LinkGoogle Scholar8. D'Ascenzo F, Moretti C, Bianco M, Bernardi A, Taha S, Cerrato E, et al. Meta-analysis of the duration of dual antiplatelet therapy in patients treated with second-generation drug-eluting stents. Am J Cardiol. 2016;117:1714-23. [PMID: 27134057] doi:10.1016/j.amjcard.2016.03.005 CrossrefMedlineGoogle Scholar9. Baber U, Mehran R, Giustino G, Cohen DJ, Henry TD, Sartori S, et al. Coronary thrombosis and major bleeding after PCI with drug-eluting stents: risk scores from PARIS. J Am Coll Cardiol. 2016;67:2224-34. [PMID: 27079334] doi:10.1016/j.jacc.2016.02.064 CrossrefMedlineGoogle Scholar10. Costa F, van Klaveren D, James S, Heg D, Räber L, Feres F, et al; PRECISE-DAPT Study Investigators. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet. 2017;389:1025-1034. [PMID: 28290994] doi:10.1016/S0140-6736(17)30397-5 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1211.Corresponding Author: J. Dawn Abbott, MD, Associate Professor of Medicine, Division of Cardiology, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, 593 Eddy Street, 814 APC, Providence, RI 02903; e-mail, [email protected]org.This article was published at Annals.org on 13 June 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoUse of the Dual-Antiplatelet Therapy Score to Guide Treatment Duration After Percutaneous Coronary Intervention Raffaele Piccolo , Giuseppe Gargiulo , Anna Franzone , Andrea Santucci , Sara Ariotti , Andrea Baldo , Carlo Tumscitz , Aris Moschovitis , Stephan Windecker , and Marco Valgimigli Metrics Cited byA new score based on the PEGASUS-TIMI 54 criteria for risk stratification of patients with acute myocardial infarctionApplication of Feedback System Control Optimization Technique in Combined Use of Dual Antiplatelet Therapy and Herbal Medicines 4 July 2017Volume 167, Issue 1Page: 57-58KeywordsAntiplatelet therapyDecision makingDrug therapyDrugsHemorrhageHospital medicineMyocardial infarctionPercutaneous coronary interventionStent implantationThrombosis ePublished: 13 June 2017 Issue Published: 4 July 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. 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