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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Tag: dual antiplatelet therapy

Update on the duration of dual antiplatelet therapy (DAPT)

Introduction

While the necessity of dual antiplatelet therapy (DAPT) following acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) with coronary stenting is undisputed, the optimal duration of DAPT remains a major topic of discussion. Research data supports both prolonged and shortened duration of DAPT in certain situations. The present paper aims to summarize current evidence and give an overview of contemporary treatment options for patients in need of dual antiplatelet therapy.

Key words: dual antiplatelet therapy, acute coronary syndrome

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Dual antiplatelet therapy: short or long after acute coronary syndrome?

What the guidelines say

According to the latest ESC guidelines for the treatment of acute coronary syndrome (ACS) patients (1) treatment recommendations are as follows:

Aspirin (acetylsalicylic acid) is recommended for all ACS patients without contraindications. The initial oral loading dose (LD) is 150–300 mg in aspirin-naive patients, the maintenance dose (MD) is 75–100 mg/day. Aspirin is usually combined with a P2Y12-inhibitor, whereby prasugrel (60 mg LD or ticagrelor are preferred over clopidogrel unless these stronger antiplatelet agents are not available or contraindications exist. The recommended duration for dual antiplatelet therapy (DAPT) after ACS is 12 months, independent of the initial treatment strategy, which is either conservative medical treatment only, percutaneous coronary intervention (PCI), or bypass surgery, respectively. (1, 2)

Key Words: clopidogrel, prasugrel, ticagrelor, dual antiplatelet therapy

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