DUAL-ANTIPLATELET THERAPY (DAPT), composed of aspirin and a P2Y12 platelet receptor
inhibitor, remains the standard of care for preventing ischemic events after acute
coronary syndrome (ACS) and percutaneous coronary intervention (PCI).
1
,
2
,
- 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: A report of the American College of Cardiology/American
Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011
ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline
for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline
for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013
ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014
AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary
Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and
Management of Patients Undergoing Noncardiac Surgery.
Circulation. 2016; 134: e123-e155
3
The 2016 American College of Cardiology-American Heart Association (ACC-AHA) guidelines
on the duration of DAPT recommend a minimum 12 months of uninterrupted DAPT after
ST-elevation myocardial infarction (STEMI) or non-STEMI ACS treated medically or with
revascularization with bare-metal stents, drug-eluting stents (DES), or coronary artery
bypass grafting (CABG) surgery.
- Windecker S
- Kolh P
- et al.
Authors/Task Force members
2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).
2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).
Eur Heart J. 2014; 35: 2541-2619
2
The interruption of DAPT (discontinuation of P2Y12 therapy) before the recommended
treatment duration increases the risk of major adverse cardiac and cerebrovascular
events, including stent thrombosis, myocardial infarction, stroke, and cardiac death.
- 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: A report of the American College of Cardiology/American
Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011
ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline
for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline
for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013
ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014
AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary
Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and
Management of Patients Undergoing Noncardiac Surgery.
Circulation. 2016; 134: e123-e155
1
,
2
,
- 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: A report of the American College of Cardiology/American
Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011
ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline
for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline
for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013
ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014
AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary
Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and
Management of Patients Undergoing Noncardiac Surgery.
Circulation. 2016; 134: e123-e155
3
Patients requiring urgent or emergent surgery within the mandatory DAPT period pose
a unique challenge for cardiologists, surgeons, and anesthesiologists—continuing DAPT
increases bleeding risk, whereas DAPT interruption may cause stent thrombosis. Interrupting
DAPT in the ambulatory setting 7 days before surgery can be especially catastrophic.- Windecker S
- Kolh P
- et al.
Authors/Task Force members
2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).
2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).
Eur Heart J. 2014; 35: 2541-2619
Key Words
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Publication history
Published online: March 01, 2023
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