Evaluating the duration of dual antiplatelet therapy in ACS patients post-PCI: A literature review

Abstract

Background: Acute coronary syndrome (ACS) patients who undergo percutaneous coronary intervention (PCI) with stents require downstream dual antiplatelet therapy (DAPT) to reduce the rates of stent thrombosis and ischemic events.(1) According to multiple guidelines, this is recommended for 1 year.(1–3) The use of dual antiplatelet therapy longer than 1 year is still debatable on whether the benefits of ischemic protection outweigh the risks of bleeding. Objective: To evaluate randomized controlled trials (RCT) that assess downstream prolonged dual antiplatelet therapy (>12 months) in acute coronary syndrome patients treated with PCI and drug-eluting stents (DES). Methods: A literature review by utilizing an online PubMed database for randomized controlled trials was conducted. Keywords used were "dual antiplatelet therapy” “dual antiplatelet treatment” “drug-eluting-stent”. Only studies conducted in the last 15 years that met the inclusion criteria were chosen. A total of 5 randomized controlled trials were selected for review. Results: One of the 5 RCT determined that prolonged dual antiplatelet therapy (>12 months) significantly reduces the rates of major cardiovascular events (MACE) such as all-cause mortality, myocardial infarction (MI), and cerebrovascular accident (CVA), as well as significantly reduces rates of stent thrombosis.(4) However, 3 of the 5 RTC determined that prolonged dual antiplatelet therapy will significantly increase the rates of moderate to severe bleeding in patients.(4–6) Conclusion: ACS patients who undergo PCI with drug-eluting stent implantation can benefit from the use of prolonged dual antiplatelet therapy to reduce major cardiovascular events, however, this would be at the cost of moderate to severe bleeding. More large scale RCT with longer follow-up are needed to determine the definitive duration of prolonged dual antiplatelet therapy.