Dual Antiplatelet Therapy for Long-Term Secondary Prevention of Atherosclerotic Cardiovascular Events

Thrombus formation is associated with Atherosclerotic Cardiovascular Diseases (ASCVD) namely acute coronary syndrome (ACS), ischemic heart disease (IHD), peripheral arterial disease (PAD), and ischemic stroke. Morbidity and mortality in such events can be minimizing thrombotic complication. The current recommendation by ACC/AHA indicates that to prevent further ischemic events is either with aspirin alone or dual antiplatelet therapy (DAPT). The recommended duration of the intervention is 1-6 months after stent placement or at least 12 months of the post-acute coronary syndrome.

The author Paul P. Dobesh and colleagues (2020) conducted a review entitled “Dual Antiplatelet Therapy for Long-Term Secondary Prevention of Atherosclerotic Cardiovascular Events” published in “the Elsevier” journal. Below is the summary of the review.

Objective                          

To review the use of DAPT beyond a year in patients with acute coronary syndrome and in patients receiving percutaneous coronary intervention with stenting.

Method

Articles published in the last 20 years that addressed the role of intervening of DAPT beyond 12 months were selected.

Findings

Data support the use of extended therapy in high ischemic risk cases. Better benefits, after acute coronary syndrome, were seen with continuing the DAPT treatment with ticagrelor 60 mg BID after 1 year. However, authors have advised calculating the risk when there is greater concern about the outcome. The risk for angiographic or PCI data can be calculated using DAPT score. Patients with low risk of bleeding and a higher risk of ischemia are the ideal patients for prolonged DAPT.

Limitation

The guidelines for long term use of DAPT is not yet fully developed. Thus, the authors have concluded that paper by saying that clinical judgement about the therapy should not be replaced by a scoring system. The scoring system should be used as a compliment.