From the Guidelines
The recommended duration of dual antiplatelet therapy (DAPT) after angiogram with percutaneous transluminal angioplasty (PTA) is up to 6 months, with the default strategy being aspirin 75–100 mg and clopidogrel 75 mg daily, as stated in the 2024 ESC guidelines 1. The duration of DAPT can vary based on the patient's clinical context, including their bleeding and ischemic risk.
- For patients at high bleeding risk but not at high ischemic risk, DAPT can be discontinued 1–3 months after PCI and single antiplatelet therapy can be continued 1.
- In patients who are not at high bleeding risk nor at high risk of ischemic events, stopping DAPT after 1–3 months from PCI-stenting may be considered 1.
- For patients undergoing high-thrombotic risk stenting, prasugrel or ticagrelor may be considered instead of clopidogrel, for the first month, and up to 3–6 months 1. It's essential to individualize the DAPT duration based on the specific anatomic location of intervention, patient risk factors, and the type of device used, as well as to balance the benefits of preventing thrombotic complications with the risks of bleeding, as highlighted in the 2018 ESC focused update on dual antiplatelet therapy in coronary artery disease 1. Key considerations include:
- The benefits and risks of DAPT, including the reduction of stent thrombosis and the increased risk of bleeding 1.
- The importance of mitigating bleeding complications while on DAPT, including access site selection, modulation of modifiable risk factors, and routine use of PPI 1.
- The selection of the appropriate P2Y12 inhibitor, with clopidogrel being the default option in patients with stable CAD treated with PCI, and ticagrelor or prasugrel being recommended in ACS patients unless contraindicated 1.
From the FDA Drug Label
Patients were randomized to receive prasugrel (60 mg loading dose followed by 10 mg once daily) or clopidogrel (300 mg loading dose followed by 75 mg once daily), with administration and follow-up for a minimum of 6 months (actual median 14. 5 months).
The recommended duration of Dual Antiplatelet Therapy (DAPT) after angiogram and Percutaneous Transluminal Angioplasty (PTA) is at least 6 months, as patients in the study were administered the drug for a minimum of 6 months, with a median follow-up of 14.5 months 2.
From the Research
Dual Antiplatelet Therapy (DAPT) Duration
The recommended duration of Dual Antiplatelet Therapy (DAPT) after angiogram and Percutaneous Transluminal Angioplasty (PTA) varies based on patient characteristics and risk factors.
- For patients with acute coronary syndrome (ACS), the American College of Cardiology/American Heart Association (ACC/AHA) recommends aspirin plus a P2Y12 inhibitor for at least 12 months 3.
- However, the optimal duration of DAPT beyond 1 year is not well established, and recommendations vary according to the risk of bleeding 3, 4.
- If bleeding risk is low, prolonged DAPT may be considered, while shorter duration (3-6 months) of DAPT may be reasonable if bleeding risk is high 3, 5.
- Recent studies suggest that de-escalation or abbreviation of DAPT may be effective in reducing bleeding risk without increasing ischemic events 6, 7.
Patient-Specific Factors
Patient characteristics, such as age, body weight, diabetes, and prior bleeding, can influence the recommended duration of DAPT.
- Patients at higher risk of bleeding, such as those 65 years old or older, with low body weight (BMI <18.5), diabetes, or prior bleeding, may require shorter DAPT duration 3.
- The use of oral anticoagulants may also impact the recommended DAPT duration 3.
Ongoing Research
Ongoing studies, such as the IVUS-ACS and ULTIMATE-DAPT trial, aim to determine the optimal DAPT duration in patients with ACS undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation 7.
- These studies will provide novel insights into the efficacy and safety of different antiplatelet strategies and help guide clinical decision-making.