Questions surround dual antiplatelet therapy duration after PCI with drug-eluting stents

Current guidelines in the U.S. recommend patients take dual antiplatelet therapy for at least a year after PCI with drug-eluting stents. The guidelines on the duration of dual antiplatelet therapy may be soon altered, however, based on results of recent studies.

In a trial published in the Journal of the American College of Cardiology last month, researchers from Columbia University found that 6.2 percent of patients had post-discharge bleeding within two years of undergoing successful PCI with drug-eluting stents. The study included 8,582 patients at 11 hospitals in the U.S. and Europe.

Post-discharge bleeding was the strongest predictor of two-year mortality, was associated with higher rates of all-cause mortality and was more common than post-discharge MI. The dual antiplatelet regimen consisted of aspirin and clopidogrel.

Gregg W. Stone, MD, a study author from Columbia, was also one of the researchers involved in a meta-analysis published in the Lancet in March that found dual antiplatelet therapy beyond a year was associated with increased mortality and bleeding compared with a shorter duration of therapy.

“There will be new guidance coming out soon from U.S. committees on duration of antiplatelet therapy,” Stone told Cardiovascular Business. “Preventing post-discharge bleeding is essential.”

Dual antiplatelet therapy protects against long-term MI and stent thrombosis. However, Stone said physicians should weigh the benefits of the treatment regimen in preventing ischemic complications with the risks in causing bleeding.

“In my opinion, the data is quite clear that we need an individualized approach to each patient when we’re considering the duration of dual antiplatelet therapy,” Stone said. “Patients who are at a high risk of ongoing ischemic complications and relatively low risk of bleeding should likely have prolonged dual antiplatelet therapy prescribed, whereas patients who are at relatively low ischemic risk but are at high risk of bleeding or even average risk of bleeding would likely have a more limited course of dual antiplatelet therapy. Our present study would support that position.”