From the Guidelines
Dual Antiplatelet Therapy (DAPT) is generally recommended for 12 months in patients with Non-ST-Elevation Myocardial Infarction (NSTEMI) post Percutaneous Coronary Intervention (PCI), unless there are contraindications 1. The recommended duration of DAPT can be adjusted based on individual clinical judgment, taking into account the patient's ischemic and bleeding risk, the occurrence of adverse events, comorbidities, co-medications, and the availability of the respective drugs. Some key points to consider when determining the duration of DAPT include:
- The type of stent used, with some studies suggesting that drug-eluting stents may require longer durations of DAPT 1
- The patient's bleeding risk, with those at high risk potentially requiring shorter durations of DAPT
- The patient's ischemic risk, with those at high risk potentially benefiting from extended durations of DAPT The choice of P2Y12 inhibitor should be individualized based on patient characteristics, with ticagrelor or prasugrel generally preferred over clopidogrel in higher-risk patients due to their more potent antiplatelet effects, unless contraindicated by bleeding risk factors 1. In patients with high bleeding risk, discontinuation of P2Y12 receptor inhibitor therapy after 6-12 months should be considered, while in patients at very high risk of bleeding, 1 month of aspirin and clopidogrel may be considered 1. Overall, the decision to extend or shorten the duration of DAPT should be made on a case-by-case basis, taking into account the individual patient's risk factors and clinical characteristics.
From the Research
Dual Antiplatelet Therapy Duration for NSTEMI Post PCI
The recommended duration of Dual Antiplatelet Therapy (DAPT) for Non-ST-Elevation Myocardial Infarction (NSTEMI) post Percutaneous Coronary Intervention (PCI) is a topic of ongoing research and debate.
- Current guidelines recommend 6-12 months of DAPT after PCI, followed by aspirin monotherapy indefinitely 2.
- Studies have investigated the efficacy and safety of shorter DAPT regimens, including 1-3 months of DAPT followed by single antiplatelet therapy (SAPT) with aspirin or a P2Y12 inhibitor 3, 4.
- A meta-analysis of randomized clinical trials found that short-term DAPT (≤3 months) followed by SAPT was associated with similar rates of major bleeding, mortality, and stroke compared to standard DAPT (6-12 months) 3.
- Another study found that 1-3 months of DAPT reduced major bleeding without increasing ischemic events compared to longer DAPT durations 4.
- A randomized, multicentre, non-inferiority trial found that 6 months of DAPT was non-inferior to 12 months of DAPT in patients with event-free ST-elevation myocardial infarction (STEMI) at 6 months after primary PCI with second-generation drug-eluting stents 5.
- The optimal duration of DAPT after PCI with drug-eluting stents is still unclear, and further research is needed to define the best treatment strategy 6, 4.