Dual antiplatelet therapy (DAPT) consisting of aspirin and P2Y12 receptor antagonists is the mainstream pharmacological therapy for prevention of thrombotic adverse events in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES).1,2 The duration and intensity of DAPT differs according to clinical indication—chronic coronary syndromes (CCS) vs. acute coronary syndromes (ACS)—and the levels of ischaemic and bleeding risks in individual patients.1,2 Shortcomings have been identified with strategies of both prolonged DAPT (including bleeding and cost issues) and short DAPT (thrombotic complications), highlighting the need to strike the delicate balance between reducing ischaemic cardiovascular events while preventing bleeding. Of note, although the risk of ischaemic and bleeding complications differs considerably in CCS and ACS...
The value of network meta-analyses in comparative effectiveness research is well established. Notwithstanding, the results of a network meta-analysis should be used not only to derive information on comparative effectiveness, but also to identify gaps in available evidence and therefore appropriately plan future trials to update existing evidence and enhance precision of estimates of the available interventions.13,14 As shown in Figure 1, several DAPT strategies in heterogenous populations have been evaluated so far and additional new comparisons are evaluated in ongoing trials, while the clinical decision for the appropriate DAPT regimen and duration on an individual patient level remains complex and multidimensional. Future research efforts should focus on the evaluation of personalized approaches (i.e. including risk prediction models, platelet function tests, or genetic tests) in which the ischaemic and bleeding risk of each patient will be jointly considered to define the optimal duration and intensity of DAPT.
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