Background: Dual antiplatelet therapy (DAPT) is one of the cornerstones of
coronary artery disease (CAD) treatment. Standard DAPT requires one of, P2Y12 receptor
inhibitors, clopidogrel, prasugrel or ticagrelor as an adjunct therapy to aspirin administration.
The decision over DAPT duration depends on the evaluation of thrombotic risk and the
assessment of the probability for major bleeding events. Methods: The goal of this work was
to identify which would be the appropriate combination of antiplatelet agents and the optimal
duration of DAPT, based on the patient’s medical history and clinical characteristics. A
thorough search of PubMed and the Cochrane Database was conducted in order to identify
randomized controlled trials, observational studies, current ESC and ACC/AHA guidelines
and novel articles on the subject. Results: The decision over DAPT duration is based on a
careful approach which requires the evaluation of thrombotic risk and the assessment of the
probability for major bleeding events. A series of aspects and special conditions may influence
the duration of DAPT after stenting e.g. the type of the implanted stent (DES or BMS) or if the commencement
of DAPT is administered in the context of an acute coronary syndrome or in the setting of stable CAD.
Current guidelines can assist clinicians in making decisions but treating patients in special groups e.g. with diabetes
mellitus or the elderly people can be very demanding. Conclusion: Studies which examined optimal DAPT
duration, displayed controversial results, mainly observed because of the discrepancy and heterogeneity between
different study designs or the decision of a great proportion of investigators to statistically test for non-inferiority.
A careful, patient-centered approach, which considers thrombotic risk versus the risk for bleeding complications
and other individual characteristics and comorbidities, is required when deciding DAPT duration.
Keywords: Antiplatelet treatment, cardiovascular diseases, clopidogrel, coronary artery disease, percutaneous coronary intervention.
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