Erschienen in:
26.06.2018
Lights and shadows of long-term dual antiplatelet therapy in “real life” clinical scenarios
verfasst von:
Marino Scherillo, Plinio Cirillo, Dario Formigli, Giulio Bonzani, Paolo Calabrò, Paolo Capogrosso, Pio Caso, Giovanni Esposito, Rosario Farina, Paolo Golino, Tonino Lanzillo, Franco Mascia, Ciro Mauro, Federico Piscione, Girolamo Sibilio, Bernardino Tuccillo, Bruno Villari, Bruno Trimarco
Erschienen in:
Journal of Thrombosis and Thrombolysis
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Ausgabe 4/2018
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Abstract
Dual antiplatelet therapy (DAPT) is a cornerstone of treatment for patients with acute coronary syndromes (ACS). Mounting evidences have opened the debate about the optimal DAPT duration. Considering the ACS-pathophysiology, the most recent guidelines recommend DAPT in all ACS patients for at least 12 months unless there are contraindications such as excessive risk of bleeding. Thus, it can be considered acceptable earlier discontinuation if the risk of morbidity from bleeding outweighs the anticipated benefit. On the other hand, several studies have clearly indicated that a significant burden of platelet related-events, such as stroke and new ACS might occur after this period, suggesting that potential benefits might derive by prolonging DAPT beyond 12 months (Long DAPT). Indeed, although current guidelines give some indications about patients eligible for Long DAPT, they do not embrace several real-life clinical scenarios. Thus, in such scenarios, how to decide whether a patient is eligible for Long DAPT or not might be still challenging for clinicians. This position paper presents and discusses various “real-life” clinical scenarios in ACS patients, in order to propose several possible recommendations to overcome guidelines potential limitations.