Dual antiplatelet therapy equally effective in acute coronary syndrome

The appropriate duration of dual antiplatelet therapy in patients at high risk for bleeding after the implantation of a drug-eluting coronary stent remains unclear. Valgimigli et al have shown that 1 month of dual antiplatelet therapy (DAPT) is noninferior to the continuation of therapy for at least 2 additional months with regard to the occurrence of net adverse clinical events and major adverse cardiac or cerebral events; along with the added advantage of lower incidence of major or clinically relevant nonmajor bleeding. The results of this multicenter, randomized, open-label, noninferiority trial with sequential superiority testing were published in the latest issue of NEJM last week.

Prolonged dual antiplatelet therapy is the treatment of choice for patients with an acute coronary syndrome who have undergone percutaneous coronary intervention (PCI) with a drug-eluting stent. The rationale is anchored in the understanding that drug-eluting stents impair the vascular healing process, because exposure of the metal in the stent serves as a nidus for stent thrombosis. But the ideal duration of this therapy is still a gray area for stable angina patients undergoing PCI.

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One Month DAPT Non-Inferior To Standard Regimens In High Bleeding Risk Patients: MASTER DAPT Trial