Although several studies investigated shorter than 12 months DAPT durations in mixed (ACS and/or PCI) populations, evidence on short DAPT followed by aspirin monotherapy in ACS patients is limited. The largest trial is the SMART DATE which randomized 2712 unselected ACS patients to 6 versus 12 months of DAPT (mainly clopidogrel-based) followed by aspirin monotherapy. DAPT for 6 months followed by aspirin monotherapy resulted in lower bleeding at a cost of MI excess compared with standard DAPT [[10]]. A similar signal was observed in the ACS subgroup of the One-Month DAPT trial [[11]]. Therefore, a DAPT de-escalation in duration (up to 6 months) followed by aspirin monotherapy seems not justifiable in ACS patients who are not at high bleeding risk (HBR), defined according to the Academic Research Consortium (ARC) – HBR criteria or a PRECISE DAPT ≥ 25.
De-escalation in intensity or duration of dual antiplatelet therapy in patients with coronary artery disease: More than alternative treatment options
Caglioni, Serena;
2023
Abstract
Although several studies investigated shorter than 12 months DAPT durations in mixed (ACS and/or PCI) populations, evidence on short DAPT followed by aspirin monotherapy in ACS patients is limited. The largest trial is the SMART DATE which randomized 2712 unselected ACS patients to 6 versus 12 months of DAPT (mainly clopidogrel-based) followed by aspirin monotherapy. DAPT for 6 months followed by aspirin monotherapy resulted in lower bleeding at a cost of MI excess compared with standard DAPT [[10]]. A similar signal was observed in the ACS subgroup of the One-Month DAPT trial [[11]]. Therefore, a DAPT de-escalation in duration (up to 6 months) followed by aspirin monotherapy seems not justifiable in ACS patients who are not at high bleeding risk (HBR), defined according to the Academic Research Consortium (ARC) – HBR criteria or a PRECISE DAPT ≥ 25.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
