ACC/AHA Update Guidelines for Antiplatelet Therapy in CAD Patients

New guidelines from the American College of Cardiology and the American Heart Association has shortened the recommended course of dual antiplatelet therapy (DAPT) for certain patients with coronary artery disease.

Note: "Although there are several potential combinations of antiplatelet therapy, the term and acronym DAPT has been used to specifically refer to combination antiplatelet therapy with aspirin and a P2Y12 receptor inhibitor (clopidogrel, prasugrel, or ticagrelor)."
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The focused update comes in response to the analysis of 11 studies assessing various durations of DAPT in patients treated with coronary stent implantation and a large, randomized controlled trial of patients that assessed the efficacy of DAPT compared with aspirin monotherapy in patients 1-3 years after myocardial infarction.

The updated guidelines recommended:

  • Clopidogrel for a minimum of 6 months in patients treated with drug-eluting stents
  • Extended DAPT continuation in patients with low bleeding risk
  • Shorter duration DAPT in patients at lower ischemic risk with high bleeding risk, longer DAPT for patients at elevated ischemic risk with low bleeding risk.
  • Clopidogrel, prasugrel, or ticagrelor for 12 months in patients with acute coronary syndrome
  • Aspirin continuation in patients on DAPT who undergo surgical procedures following coronary stent implantation that requires the discontinuation of P2Y12  inhibition
  • Indefinite daily aspirin (recommended dose is 81 mg) in patients treated with DAPT

The full guidelines were published in the Journal of the American College of Cardiology.

—Michael Potts

Reference:

Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease [published online March 2016]. J Am Coll Cardiol. doi:10.1016/j.jacc.2016.03.513.