Should dual antiplatelet therapy after drug-eluting stents be continued for more than 1 year?Response to Colombo and Gerber
Dual Antiplatelet Therapy After Drug-Eluting Stents Should Not Be Continued for More Than 1 Year and Preferably Indefinitely
Drug-eluting stents (DES) have significantly reduced the occurrence of in-stent restenosis with a coexistent reduction in revascularization compared with bare metal stents (BMS).1–4 In September 2006, at the World Congress of Cardiology/European Society of Cardiology in Barcelona, a signal appeared of increased risk with DES more than BMS, namely that of late stent thrombosis.5 Although the concerns at that time were overemphasized and hyped6 by the media, when the smoke settled, more rigorous studies7 and standardized definitions of stent thrombosis8 demonstrated real ongoing concerns of late stent thrombosis.9 Potential mechanisms for stent thrombosis are described in Figure 110–15 and in the Table.11,14–28 Subsequent studies then suggested possible benefits from prolonged (>6 months) dual antiplatelet therapy (DAT) after DES implantation in reduction in clinical events.29,30 This prompted the Food and Drug Administration (FDA) to issue a guideline that patients should take DAT for up to 12 months after DES insertion based on indirect data and without a specific prospective study.31 We think the best way to address these issues is with the following Life Scenario.
Response by Chhatriwalla and Bhatt p 217
A Life Scenario