How long should dual antiplatelet therapy be given after a drug-eluting stent insertion?

This paper studied how long dual antiplatelet therapy should be given for after a drug-eluting stent insertion. The authors concluded that continuing dual antiplatelet therapy beyond 12 months can be carefully considered in selected patients with low bleeding risk. 

A drug-eluting stent is a mesh wire structure that releases medication. It is placed into the blood vessel to prevent the blood vessel from narrowing and allow blood to flow to the heart. The medication decreases the risk of a blockage reforming in the vessel.

After a drug-eluting stent is placed, antiplatelet drugs are given to prevent blood from clotting. Dual antiplatelet therapy refers to treatment with 2 types of antiplatelet drugs, and it is usually given for 6-12 months. It is unclear what the best duration of dual antiplatelet therapy (DAPT) should be.

11 studies including 33,520 participants were analyzed. These studies compared short-term DAPT of less than 12 months to long-term DAPT of more than 12 months. Clopidogrel (Plavix) and aspirin were the most common combination of DAPT given.

Compared to 12-month DAPT, DAPT of more than 12 months significantly reduced the occurrence of a heart attack by 46%, and reduced the occurrence of blood clotting in the stent by 64%. There was no significant difference in the risk of death from heart-related causes, or stroke, or having a repeat procedure. However, there was a 43% higher risk of death due to any cause and 54% higher risk of major bleeding.   

Compared to short-term DAPT, DAPT of 12 months and more was not significantly different in the risk of heart attack, death and stroke. There was also no significant difference in the occurrence of blood clotting in the stent or having a repeat procedure. However, the risk of bleeding was 98% higher.

The authors concluded that an extended DAPT reduced the occurrence of heart attacks but increased the risk of bleeding. They suggested that patients who are at high risk of bleeding should have shorter DAPT while those at low risk of bleeding can be considered for DAPT beyond 12 months. 

Talk to your doctor about how long you should receive dual antiplatelet therapy.