Long-term antiplatelet therapy: from clinical trials to clinical application
Current Opinion in Cardiology, 06/26/2012
Chew DP et al. – Evolving evidence and new therapies may enable shorter duration dual antiplatelet therapy.
- Recent evidence with vorapaxar has demonstrated an increase in bleeding events with only modest improvement in ischemic outcomes.
- Platelet function testing to inform clopidogrel dose selection has not shown improvement in clinical outcome.
- The impact of CYP2C19 loss–of–function alleles on clopidogrel effect may be more modest than initially reported, though an impact on stent thrombosis is evident.
- Among patients receiving current generation drug eluting stents, 6 months of dual antiplatelet therapy may provide similar ischemic outcomes with fewer bleeding events compared with 12 or 24 months of therapy.
- Novel anticoagulants entering clinical practice will also potentially influence the clinical decisions regarding the duration of dual antiplatelet therapy.
- Studies focussing on the discontinuation of aspirin as opposed to the P2Y12 inhibitor to reduce late bleeding risk should be considered.