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Nat Rev Cardiol. 2017 May;14(5):294-303. doi: 10.1038/nrcardio.2017.12. Epub 2017 Feb 9.

Single or dual antiplatelet therapy after PCI.

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Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
Academic Medical Center, Meibergdreef 9, B2-127, 1105 AZ Amsterdam, The Netherlands.
Northern Region Heart Center, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, 110 Intavaroros Road, Sripoom District, Muang, Chiang Mai, 50200, Thailand.
Department of Cardiology, Siddhartha Medical College and Government General Hospital, Ring Road, Gunadala, Vijayawada-520 008, Andhra Pradesh, India.
Cardialysis, Westblaak 98, 3012 KM, Rotterdam, The Netherlands.
Imperial College London, Kensington, London SW7 2AZ, UK.


The optimal duration and type of antiplatelet therapy after implantation of a drug-eluting stent (DES) remains uncertain. At the time of the first-in-man implantation of the sirolimus DES in 1999, the protocol-defined dual antiplatelet therapy (DAPT) duration was only 2 months. Subsequently, DAPT duration was extended to 1 year on the basis of anecdotal historical data, and this practice was then incorporated into clinical guidelines. For >1 decade, trialists have sought to compare the safety and efficacy of abbreviated (<6 months) and prolonged (>12 months) DAPT regimens. However, the body of evidence is limited by the heterogeneity of end points, time of randomization, and bleeding criteria used in each trial. Pharmaceutical advances led to the introduction of new ADP-receptor antagonists, which are thought to be more effective than clopidogrel. The ADP-receptor antagonists moved the focus from the optimal duration of DAPT to the potential efficacy of single antiplatelet therapy after DES implantation. In this Review, we summarize the current evidence on the duration of DAPT and the risk of bleeding and adverse cardiac events after DES implantation, and describe the pitfalls of trial interpretation. The ongoing, prospective trials to test single antiplatelet therapy after DES implantation are also discussed.

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