Duration of dual antiplatelet therapy in acute coronary syndrome

Wilson, S. J., Newby, D. E., Dawson, D., Irving, J. and Berry, C. (2017) Duration of dual antiplatelet therapy in acute coronary syndrome. Heart, 103(8), pp. 573-580. (doi:10.1136/heartjnl-2016-309871) (PMID:28249994) (PMCID:PMC5529971)

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Abstract

Despite a large volume of evidence supporting the use of dual antiplatelet therapy in patients with acute coronary syndrome, there remains major uncertainty regarding the optimal duration of therapy. Clinical trials have varied markedly in the duration of therapy, both across and within trials. Recent systematic reviews and meta-analyses suggest that shorter durations of dual antiplatelet therapy are superior because the avoidance of atherothrombotic events is counterbalanced by the greater risks of excess major bleeding with apparent increases in all-cause mortality with longer durations. These findings did not show significant heterogeneity according to whether patients had stable or unstable coronary heart disease. Moreover, the potential hazards and benefits may differ when applied to the general broad population of patients encountered in everyday clinical practice who have markedly higher bleeding and atherothrombotic event rates. Clinicians lack definitive information regarding the duration of therapy in patients with acute coronary syndrome and risk scores do not appear to be sufficiently robust to address these concerns. We believe that there is a pressing need to undertake a broad inclusive safety trial of shorter durations of therapy in real world populations of patients with acute coronary syndrome. The clinical evidence would further inform future research into strategies for personalised medicine.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Newby, Professor David
Authors: Wilson, S. J., Newby, D. E., Dawson, D., Irving, J., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Heart
Publisher:BMJ Publishing Group
ISSN:1355-6037
ISSN (Online):1468-201X
Published Online:10 February 2017
Copyright Holders:Copyright © 2017 The Authors
First Published:First published in Heart 103(8):573-580
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
637071BHF Centre for regenerative medicineAndrew BakerBritish Heart Foundation (BHF)RM/13/2/30158RI CARDIOVASCULAR & MEDICAL SCIENCES