หลัง stent aspirin plus clopidogrel 6 เดือน ต่อด้วย aspirin ยัง OK Six Months of Dual Antiplatelet Therapy Non-Inferior to 24 Months Following PCI November 20, 2014 By Walter Alexander CHICAGO -- November 20, 2014 -- A study comparing 6 months of dual antiplatelet therapy (DAPT) with 24 months of DAPT following percutaneous coronary intervention (PCI) with a drug-eluting stent showed that the shorter therapy was non-inferior to the therapy of longer duration. Results from the ITALIC Plus trial showed that outcomes after PCI with a drug-eluting stent were similar among patients who were randomised DAPT for 24 months (followed by aspirin) and patients who were randomised to 6 months of DAPT (followed by aspirin). The findings were presented here at the 2014 Annual Meeting of the American Heart Association (AHA) by Martine Gilard, MD, University of Brest, Cedex, France. The currently recommended duration of DAPT in DES recipients is 12 months to reduce the risk of late stent thrombosis. However, DAPT is associated with increased bleeding which may affect the outcome of patients especially those with co-morbidities or requiring surgical treatment. For the study, researchers enrolled patients undergoing PCI with at least 1 drug-eluting stent. All patients were pre-treated with aspirin plus clopidogrel, prasugrel or ticagrelor. Patients who experienced no events during the first 6 months after PCI were then randomised to receive aspiring alone or another 18 months of DAPT, followed subsequently by aspirin alone. The primary endpoint was the composite of death, myocardial infarction, emergency target vessel revascularisation, stroke or major bleeding within 12 months. At 1 year, the primary endpoint was reported at a rate of 1.6% in the 6-month DAPT group and at 1.5% for the 24-month DAPT group (P = .85). Major bleeding rates were 0% and 0.3%, respectively. In the subgroup of patients with acute coronary syndromes (ACS), rates of the primary endpoint and all death favoured the 24-month DAPT (hazard ratios [HRs], 1.773 and 4.041, respectively). In the non-ACS group, the primary endpoint, all death, and cardiac death favoured the 6-month therapy (HRs, 0.79, 0.660, and 0.661). However, myocardial infarction and minor bleeding favoured the 24-month therapy (HRs, 1.990 and 3.981). “I think this is very important…in our daily practice, with the new generation of drug-eluting stents, we can shorten the duration of DAPT and give aspirin alone,” said Dr. Gilard. He added that further trials are needed to confirm optimal DAPT duration for patients with ACS. [Presentation title: Risk and Benefit of Dual Antiplatelet Therapy. Abstract LBCT.01]
Posted on: Fri, 28 Nov 2014 01:24:13 +0000
Trending Topics
Recently Viewed Topics
© 2015