A focused update on dual antiplatelet therapy (DAPT) in coronary artery disease (CAD) by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) has been published in the European Heart Journal and provides a comprehensive report on DAPT efficacy and safety, risk stratification, and use of DAPT with several other interventions and therapies.1
The ESC and EACTS guidelines provide summaries of recently published clinical evidence on the many uses of DAPT in CAD, including in patients with medically managed acute coronary syndrome (ACS), during percutaneous coronary intervention (PCI), and in patients who receive coronary artery bypass grafting (CABG). The Task Force also provides gender considerations for DAPT use and for special patient populations, such as patients undergoing complex PCI or for patients with diabetes.
According to the Task Force’s guidelines, one of the evidence gaps regarding the use of DAPT in cardiac surgery includes whether or not DAPT should be used in patients with stable CAD after CABG. In addition, the Task Force also commented that the timing of restarting DAPT after a procedure remains unclear based on the current clinical evidence. The management of perioperative bleeding complications caused by DAPT is another topic currently unanswered by recent data.
The new guidelines also provide 2 risk scores for the guidance of DAPT duration: the PRECISE DAPT (Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent DAPT) score and the DAPT score. In addition, the Task Force recommends that the decision for DAPT duration “should be dynamic and reassessed during the course of the initially selected DAPT regimen.”
Valgimigli M, Bueno H, Byrne RA, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS) [published online August 26, 2017]. Eur Heart J. doi:10.1093/eurheartj/ehx419