Author + information
- Received August 5, 2009
- Revision received September 10, 2009
- Accepted September 20, 2009
- Published online December 1, 2009.
- David E. Kandzari, MD⁎,⁎ (, )
- Dominick J. Angiolillo, MD, PhD†,
- Matthew J. Price, MD⁎ and
- Paul S. Teirstein, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. David E. Kandzari, Division of Cardiovascular Disease, Scripps Green Clinic, Maildrop S1056, 10666 North Torrey Pines Road, La Jolla, California 92037
Uncertainty regarding the appropriate duration of dual antiplatelet therapy (DAPT) with aspirin and a thienopyridine challenges every clinician involved in the care of patients considered for or treated with drug-eluting stents (DES). Despite guideline recommendations for extended (≥12 months) DAPT following percutaneous coronary revascularization with DES, few data are available to guide clinical decision-making beyond consensus opinion. Yet considering the clinical implications of stent thrombosis (ST) and its unpredictability in late occurring events, comprehensive assessment of the relationship between DAPT duration and ST over the long-term is a focus for DES-related clinical trials and an essential public health measure. Despite the potential for prolonged DAPT to reduce late-term cardiovascular events related to the progression of atherosclerosis, few studies have formally examined the safety and efficacy of extended DAPT and its impact on late ST events. The purpose of this paper is to appraise the existing evidence regarding the relationship between long-term DAPT and late cardiovascular events; address outstanding (and unstudied) dilemmas related to DAPT in DES-treated patients; and propose considerations for both trial design and clinical practice.
Drs. Kandzari receives research/grant support from Medtronic CardioVascular, Inc., and receives consulting honoraria from Medtronic CardioVascular, Inc., Cordis Corporation, and Eli Lilly Co. Dr. Angiolillo receives honoraria and lecture fees from Bristol-Myers Squibb, Sanofi-Aventis, Eli Lilly Co., Daiichi Sankyo, Inc., The Medicines Company, Portola, Novartis, Medicure, Accumetrics, Arena Pharmaceuticals, and Astra Zeneca; and research grants from GlaxoSmithKline, Otsuka, Eli Lilly Co., Daiichi Sankyo, Inc., The Medicines Company, Portola Pharmaceuticals, Accumetrics, Schering-Plough, AstraZeneca, Eisai, and Johnson and Johnson. Dr. Price receives honoraria and/or lecture fees from Boston Scientific, Cordis, Abbott Vascular, and Daiichi Sankyo Inc./Eli Lilly Co.; research/grant support from Accumetrics and Bristol-Myers Squibb/Sanofi Aventis; and consulting honoraria from Daiichi Sankyo, AstraZeneca, Accumetrics, and Bristol-Myers Squibb/Sanofi Aventis. Dr. Teirstein receives research/grant support, consulting honoraria, and lecture fees from Boston Scientific Corporation, Medtronic Vascular, and Abbott Vascular.
- Received August 5, 2009.
- Revision received September 10, 2009.
- Accepted September 20, 2009.
- American College of Cardiology Foundation
- Development of DAPT Guideline Recommendations: A Brief History
- Long-Term DAPT After DES Revascularization: What Is the Evidence Basis?
- Influence of DAPT on Late ST: Effect or Epiphenomenon?
- DAPT Permanent Discontinuation Versus Transient Interruption
- Identifying the “Optimal” DAPT Duration: Considerations for Clinical Trial Design and End Point Selection