Optimal Dual Antiplatelet Therapy After Percutaneous Coronary Intervention

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 antagonist represents the standard of care in patients with acute coronary syndrome (ACS) and undergoing percutaneous coronary interventions (PCI). For patients with coronary heart disease undergoing PCI, DAPT reduces ischemic events, but may increase the risk of bleeding. In recent years, several clinical studies have been designed to explore the optimal dual antiplatelet therapy to maximize clinical benefit. However, the studies concluded contradictory results:on the one hand, the shorter duration of DAPT may reduce the risk of bleeding without increasing the incidence of ischemic events; on the other hand, longer duration of DAPT superior in the prevention of ischemic events with increasing the risk of bleeding. At the same time, High on-treatment platelet reactivity (HPR) can be as high as in one-third of patients treated with clopidogrel, Numberous studies demonstrated that HPR is a strong predictor of post-PCI ischemic events and is associated with an increased risk of cardiovascular death and thrombotic events. The usefulness of tailored antiplatelet therapy based on platelet function monitoring on clinical outcomes following PCI is still controversial.In this study, we perform meta-analysis to discuss the optimal duration of dual antiplatelet therapy and intensification of antiplatelet therapy based on platelet function testing for patients undergoing percutaneous coronary interventions.Our study showed that longer duration of dual antiplatelet therapy for patients undergoing PCI could significantly reduce the incidence of adverse cardiovascular events (MACE), but increased the incidence of bleeding events. Patients with ACS or with a high risk of thrombosis may benefit from prolonged DAPT. Patients with second-generation of DES implantation, a shorter duration of dual DAPT is not inferior to a longer period of DAPT. Long term use of newer P2Y12 receptor inhibitors may effectively reduce the incidence of adverse cardiovascular events. What’s more, in patients undergoing PCI who have HPR on platelet function testing, intensified DAPT reduces the rate of thrombotic events without increasing the risk of major bleeding compared with standard clopidogrel therapy.