Dual Antiplatelet Therapy: A Concise Review for Clinicians
Dual antiplatelet therapy (DAPT) combines two antiplatelet agents to decrease the risk of thrombotic complications associated with atherosclerotic cardiovascular diseases. Emerging data about the duration of DAPT is being published continuously. New approaches are trying to balance the time, benefit...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-07-01
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| Series: | Life |
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| Online Access: | https://www.mdpi.com/2075-1729/13/7/1580 |
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| author | Hafeez Ul Hassan Virk Johao Escobar Mario Rodriguez Eric R. Bates Umair Khalid Hani Jneid Yochai Birnbaum Glenn N. Levine Sidney C. Smith Chayakrit Krittanawong |
| author_facet | Hafeez Ul Hassan Virk Johao Escobar Mario Rodriguez Eric R. Bates Umair Khalid Hani Jneid Yochai Birnbaum Glenn N. Levine Sidney C. Smith Chayakrit Krittanawong |
| author_sort | Hafeez Ul Hassan Virk |
| collection | DOAJ |
| description | Dual antiplatelet therapy (DAPT) combines two antiplatelet agents to decrease the risk of thrombotic complications associated with atherosclerotic cardiovascular diseases. Emerging data about the duration of DAPT is being published continuously. New approaches are trying to balance the time, benefits, and risks for patients taking DAPT for established cardiovascular diseases. Short-term dual DAPT of 3–6 months, or even 1 month in high-bleeding risk patients, is equivalent in terms of efficacy and effectiveness compared to long-term DAPT for patients who experienced percutaneous coronary intervention in an acute coronary syndrome setting. Prolonged DAPT beyond 12 months reduces stent thrombosis, major adverse cardiovascular events, and myocardial infarction rates but increases bleeding risk. Extended DAPT does not significantly benefit stable coronary artery disease patients in reducing stroke, myocardial infarction, or cardiovascular death. Ticagrelor and aspirin reduce cardiovascular events in stable coronary artery disease with diabetes but carry a higher bleeding risk. Antiplatelet therapy duration in atrial fibrillation patients after percutaneous coronary intervention depends on individual characteristics and bleeding risk. Antiplatelet therapy is crucial for post-coronary artery bypass graft and transcatheter aortic valve implantation; Aspirin (ASA) monotherapy is preferred. Antiplatelet therapy duration in peripheral artery disease depends on the scenario. Adding vorapaxar and cilostazol may benefit secondary prevention and claudication, respectively. Carotid artery disease patients with transient ischemic attack or stroke benefit from antiplatelet therapy and combining ASA and clopidogrel is more effective than ASA alone. The optimal duration of DAPT after carotid artery stenting is uncertain. Resistance to ASA and clopidogrel poses an incremental risk of deleterious cardiovascular events and stroke. The selection and duration of antiplatelet therapy in patients with cardiovascular disease requires careful consideration of both efficacy and safety outcomes. The use of combination therapies may provide added benefits but should be weighed against the risk of bleeding. Further research and clinical trials are needed to optimize antiplatelet treatment in different patient populations and clinical scenarios. |
| first_indexed | 2024-03-11T00:54:00Z |
| format | Article |
| id | doaj.art-8d4ad39637ae4b6e8a4f764fdb84a1a0 |
| institution | Directory Open Access Journal |
| issn | 2075-1729 |
| language | English |
| last_indexed | 2024-03-11T00:54:00Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Life |
| spelling | doaj.art-8d4ad39637ae4b6e8a4f764fdb84a1a02023-11-18T20:10:32ZengMDPI AGLife2075-17292023-07-01137158010.3390/life13071580Dual Antiplatelet Therapy: A Concise Review for CliniciansHafeez Ul Hassan Virk0Johao Escobar1Mario Rodriguez2Eric R. Bates3Umair Khalid4Hani Jneid5Yochai Birnbaum6Glenn N. Levine7Sidney C. Smith8Chayakrit Krittanawong9Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH 44101, USAInternational Transitional Medical Graduate, American College of Physician, Philadelphia, PA 19106, USAJohn T Milliken Department of Medicine, Division of Cardiovascular Disease, Section of Advanced Heart Failure and Transplant, Barnes-Jewish Hospital, Washington University, St. Louis School of Medicine, St. Louis, MO 63110, USADivision of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USAMichael E. DeBakey VA Medical Center, Section of Cardiology, Baylor College of Medicine, Houston, TX 77030, USADivision of Cardiology, University of Texas Medical Branch, Houston, TX 77555, USAMichael E. DeBakey VA Medical Center, Section of Cardiology, Baylor College of Medicine, Houston, TX 77030, USAMichael E. DeBakey VA Medical Center, Section of Cardiology, Baylor College of Medicine, Houston, TX 77030, USADivision of Cardiology, McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USACardiology Division, NYU School of Medicine, NYU Langone Health, New York, NY 10016, USADual antiplatelet therapy (DAPT) combines two antiplatelet agents to decrease the risk of thrombotic complications associated with atherosclerotic cardiovascular diseases. Emerging data about the duration of DAPT is being published continuously. New approaches are trying to balance the time, benefits, and risks for patients taking DAPT for established cardiovascular diseases. Short-term dual DAPT of 3–6 months, or even 1 month in high-bleeding risk patients, is equivalent in terms of efficacy and effectiveness compared to long-term DAPT for patients who experienced percutaneous coronary intervention in an acute coronary syndrome setting. Prolonged DAPT beyond 12 months reduces stent thrombosis, major adverse cardiovascular events, and myocardial infarction rates but increases bleeding risk. Extended DAPT does not significantly benefit stable coronary artery disease patients in reducing stroke, myocardial infarction, or cardiovascular death. Ticagrelor and aspirin reduce cardiovascular events in stable coronary artery disease with diabetes but carry a higher bleeding risk. Antiplatelet therapy duration in atrial fibrillation patients after percutaneous coronary intervention depends on individual characteristics and bleeding risk. Antiplatelet therapy is crucial for post-coronary artery bypass graft and transcatheter aortic valve implantation; Aspirin (ASA) monotherapy is preferred. Antiplatelet therapy duration in peripheral artery disease depends on the scenario. Adding vorapaxar and cilostazol may benefit secondary prevention and claudication, respectively. Carotid artery disease patients with transient ischemic attack or stroke benefit from antiplatelet therapy and combining ASA and clopidogrel is more effective than ASA alone. The optimal duration of DAPT after carotid artery stenting is uncertain. Resistance to ASA and clopidogrel poses an incremental risk of deleterious cardiovascular events and stroke. The selection and duration of antiplatelet therapy in patients with cardiovascular disease requires careful consideration of both efficacy and safety outcomes. The use of combination therapies may provide added benefits but should be weighed against the risk of bleeding. Further research and clinical trials are needed to optimize antiplatelet treatment in different patient populations and clinical scenarios.https://www.mdpi.com/2075-1729/13/7/1580dual antiplatelet therapyDAPT |
| spellingShingle | Hafeez Ul Hassan Virk Johao Escobar Mario Rodriguez Eric R. Bates Umair Khalid Hani Jneid Yochai Birnbaum Glenn N. Levine Sidney C. Smith Chayakrit Krittanawong Dual Antiplatelet Therapy: A Concise Review for Clinicians Life dual antiplatelet therapy DAPT |
| title | Dual Antiplatelet Therapy: A Concise Review for Clinicians |
| title_full | Dual Antiplatelet Therapy: A Concise Review for Clinicians |
| title_fullStr | Dual Antiplatelet Therapy: A Concise Review for Clinicians |
| title_full_unstemmed | Dual Antiplatelet Therapy: A Concise Review for Clinicians |
| title_short | Dual Antiplatelet Therapy: A Concise Review for Clinicians |
| title_sort | dual antiplatelet therapy a concise review for clinicians |
| topic | dual antiplatelet therapy DAPT |
| url | https://www.mdpi.com/2075-1729/13/7/1580 |
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