{"id":6975,"date":"2025-05-22T12:43:28","date_gmt":"2025-05-22T09:43:28","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=6975"},"modified":"2025-05-22T12:43:28","modified_gmt":"2025-05-22T09:43:28","slug":"key-points-summary-title-is-a-year-of-dual-antiplatelet-therapy-magical-thinking","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/key-points-summary-title-is-a-year-of-dual-antiplatelet-therapy-magical-thinking\/","title":{"rendered":"Key Points Summary Title: Is a Year of Dual Antiplatelet Therapy Magical Thinking?"},"content":{"rendered":"
Key Points Summary<\/div>\n
Title: Is a Year of Dual Antiplatelet Therapy Magical Thinking?<\/div>\n
Author: Christopher Labos, MD, CM, MSc<\/div>\n
Date: May 12, 2025<\/div>\n
Source: Medscape Commentary<\/div>\n
<\/div>\n
1. Historical Context:<\/span><\/div>\n
\u2022 The CURE trial (2001) launched the era of DAPT (aspirin + clopidogrel).<\/span><\/div>\n
\u2022 Later trials (TRITON-TIMI 38 and PLATO) reinforced DAPT use, though they didn\u2019t specifically test 12-month duration.<\/span><\/div>\n
2. Why 12 Months?<\/span><\/div>\n
\u2022 Initially recommended due to high stent thrombosis rates with early-generation DES.<\/span><\/div>\n
\u2022 Persisted over time despite improvements in stents and procedural techniques.<\/span><\/div>\n
3. Evidence on Duration:<\/span><\/div>\n
\u2022 DAPT trial: 30 months > 12 months in preventing events, but increased bleeding.<\/span><\/div>\n
\u2022 Meta-analyses: Longer DAPT reduces CV events but raises bleeding risk.<\/span><\/div>\n
\u2022 Shorter durations (3\u20136 months) show no significant increase in events but reduce bleeding.<\/span><\/div>\n
4. Alternative Approaches:<\/span><\/div>\n
\u2022 Some trials suggest stopping aspirin and continuing P2Y12 inhibitors (e.g., ticagrelor).<\/span><\/div>\n
\u2022 Trials:<\/span><\/div>\n
\u2022 SMART-CHOICE: clopidogrel after 3 months.<\/span><\/div>\n
\u2022 STOPDAPT-2: clopidogrel after 1 month.<\/span><\/div>\n
\u2022 TWILIGHT: ticagrelor monotherapy after 3 months.<\/span><\/div>\n
5. Recent Trials:<\/span><\/div>\n
\u2022 HOST-BR: 1 month vs 3 vs 12 months DAPT based on bleeding risk.<\/span><\/div>\n
\u2022 High bleeding risk: 1 month increased events.<\/span><\/div>\n
\u2022 Low bleeding risk: 3 months reduced bleeding, no increase in events.<\/span><\/div>\n
\u2022 SMART-CHOICE 3: clopidogrel vs aspirin after standard DAPT; clopidogrel reduced events.<\/span><\/div>\n
6. Ethnic and Regional Variations:<\/span><\/div>\n
\u2022 Korean and East Asian populations show different responses (e.g., better tolerance to clopidogrel).<\/span><\/div>\n
\u2022 Results may not generalize globally.<\/span><\/div>\n
7. Guideline Position \u2013 2025 ACC\/AHA ACS Guidelines:<\/span><\/div>\n
\u2022 Still recommend 12 months DAPT (Class 1A) unless high bleeding risk.<\/span><\/div>\n
\u2022 Alternatives:<\/span><\/div>\n
\u2022 Ticagrelor monotherapy after 1 month (Class 1A).<\/span><\/div>\n
\u2022 Switch to clopidogrel or monotherapy (Class 2B).<\/span><\/div>\n
8. Practical Realities:<\/span><\/div>\n
\u2022 Clinical inertia and fear of thrombosis contribute to default 12-month use.<\/span><\/div>\n
\u2022 Primary care often defers to cath lab reports recommending full-year DAPT.<\/span><\/div>\n
9. Conclusion:<\/span><\/div>\n
\u2022 No high-quality evidence has ever definitively shown that 12 months is superior.<\/span><\/div>\n
\u2022 Shorter DAPT durations may be equally effective and safer for many patients.<\/span><\/div>\n
\u2022 Clinical decisions should be personalized based on ischemic vs bleeding risk.<\/span><\/div>\n
Link: Medscape article<\/div>\n
https:\/\/click.mail.medscape.com\/?qs=3900ddeba56641e3ed0bad23a5cb4741029ebccf434b58ace2c85899002036111c39fbedf94247580b7eb95cd91dcd17b1ea120fd687c22b0733e4cc7ad27284<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"

Key Points Summary Title: Is a Year of Dual Antiplatelet Therapy Magical Thinking? Author: Christopher Labos, MD, CM, MSc Date: May 12, 2025 Source: Medscape Commentary 1. Historical Context: \u2022 The CURE trial (2001) launched the era of DAPT (aspirin + clopidogrel). \u2022 Later trials (TRITON-TIMI 38 and PLATO) reinforced DAPT use, though they didn\u2019t […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-6975","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/6975","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=6975"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/6975\/revisions"}],"predecessor-version":[{"id":6976,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/6975\/revisions\/6976"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=6975"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=6975"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=6975"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}