Is a short or long duration anti-platelet therapy better after stent ?

This paper studied how long patients should have dual-antiplatelet therapy after a drug-eluting stent placement.

Drug-eluting stents are devices inserted into the blood vessel to widen it. These stents also release medication, and reduce the likelihood of having further procedures. After a stent placement, medications are given to prevent blood from sticking together. A dual-antiplatelet therapy involves aspirin given in combination with a P2Y12 inhibitor. Examples of P2Y12 inhibitors are  clopidogrel (Plavix), ticagrelor (Brilinta), or prasugrel (Effient). While this effectively prevents blood from clumping together in the stent, it is unclear how long this therapy should be given.

The authors looked at 9 various trials, including 28,088 patients, where patients received dual-antiplatelet therapy. They compared patients who received longer duration therapy with patients who received shorter duration therapy.

Patients assigned to longer duration therapy had a 19% higher risk of death than patients assigned to shorter-duration therapy. 5 studies suggested that there was no significant difference in rates of death from heart-related causes between patients receiving longer and shorter duration therapy.

Patients assigned to longer-duration therapy were 27% less at risk of a heart attack than patients assigned to a shorter-duration therapy. Patients assigned to longer-duration therapy had a 63% higher risk of a major bleeding event than patients assigned to shorter duration therapy. The risk of stroke was similar among patients assigned to longer or shorter duration therapy. Patients assigned to longer duration therapy had a 12% higher risk of having further procedures to restore blood supply than patients assigned to a shorter duration therapy.  

The authors concluded that a longer dual anti-platelet therapy is associated with fewer heart attacks but more major bleeding events than shorter-duration therapy. 

The quality of the results was moderate. The definition of short and long duration varied among the studies.

Talk to your doctor about what kind of therapy you prefer after stent placement.