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 |
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Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Newby, Professor David and Berry, Professor Colin |
Authors: | Wilson, S. J., Newby, D. E., Dawson, D., Irving, J., and Berry, C. |
College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
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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