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Dual antiplatelet therapy after percutaneous coronary intervention for stable CAD or ACS

Redefining the optimal duration of treatment

Duale plättchenhemmende Therapie nach perkutaner Koronarintervention bei stabiler KHK oder ACS

Aktuelle Empfehlungen zur optimalen Therapiedauer

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Abstract

The duration and combination of dual antiplatelet therapy after coronary stent implantation, consisting of aspirin and a P2Y12 inhibitor, is among the most intensely investigated therapeutic strategies in cardiovascular medicine. While initial studies have mainly focused on the efficacy and safety of individual antithrombotic agents, the increased need for a personalized, risk-based approach to define the optimal duration of antithrombotic treatment according to the estimated ischemic and bleeding risk was then recognized. Recent recommendations for the optimal duration of antithrombotic combination therapies following coronary stent implantation in various clinical scenarios have substantially changed. The aim of the present article is to discuss the recent evidence from randomized clinical trials and observational studies with respect to antithrombotic treatment regimens in patients undergoing coronary artery stenting for stable coronary artery disease (CAD) or an acute coronary syndrome (ACS). We will focus on optimal treatment duration and a personalized approach based on ischemic and bleeding risk assessment.

Zusammenfassung

Die Dauer und Zusammensetzung der dualen antiaggregatorischen Therapie nach koronarer Stentimplantation, bestehend aus Aspirin und einem P2Y12-Rezeptor-Inhibitor, gehört zu den meist untersuchten Therapiestrategien in der kardiovaskulären Medizin. Während in den ersten Studien der Fokus v. a. auf der Wirksamkeit und Sicherheit antithrombotischer Substanzen lag, wurde im Verlauf die Notwendigkeit zur Beurteilung der optimalen Therapiedauer und der individuellen Risikostratifizierung bezüglich ischämischer Ereignisse und Blutungsneigung untersucht. Die aktuellen Empfehlungen bezüglich der optimalen antithrombotischen Therapie nach koronarer Stentimplantation haben sich erheblich verändert. Im vorliegenden Artikel wird die aktuelle Datenlage anhand von randomisierten kontrollierten und Beobachtungsstudien zur antithrombotischen Therapie nach perkutaner koronarer Revaskularisation bei stabiler koronarer Herzkrankheit (KHK) oder akutem Koronarsyndrom (ACS) zusammengefasst. Im Fokus stehen dabei Studien und Empfehlungen zur optimalen Dauer der antithrombotischen Therapie und zu einem personalisierten risikobasierten Therapieansatz in Bezug auf ischämische Ereignisse und Blutungen.

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Authors and Affiliations

  1. Department of Cardiology, Charité – Universitätsmedizin Berlin (Benjamin Franklin Campus), Hindenburgdamm 30, 12203, Berlin, Germany

    B. E. Stähli &  U. Landmesser

  2. Deutsches Zentrum für Herz-Kreislaufforschung (DZHK)—Partner Site Berlin, Berlin, Germany

    B. E. Stähli &  U. Landmesser

  3. Berlin Institute of Health (BIH), Berlin, Germany

    U. Landmesser

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Correspondence to U. Landmesser.

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B.E. Stähli and U. Landmesser declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Stähli, B.E., Landmesser, U. Dual antiplatelet therapy after percutaneous coronary intervention for stable CAD or ACS. Herz 43, 11–19 (2018). https://doi.org/10.1007/s00059-017-4654-2

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