The optimal duration of dual antiplatelet therapy after implantation of drug-eluting coronary stents: an unanswered question
The efficacy and safety of percutaneous coronary interventions have been improved by the advent of drug-eluting stents (DES) in conjunction with adjunctive medical treatment (1). Although previous studies have demonstrated the efficacy of DES in reducing neointimal hyperplasia and clinical restenosis compared to bare-metal stents (2,3), the increased incidence of late or very late stent thrombosis after DES implantation remains an important concern due to its clinical consequences, including myocardial infarction and death in up to 80% (4-6). Early stent thrombosis is largely independent of stent type and mainly related to procedural variables, such as major edge dissections and stent underexpansion (7). In contrast, the mechanisms underlying late or very late stent thrombosis are still poorly defined, but premature of dual antiplatelet therapy (DAPT) discontinuation may play a major role (8). Nevertheless, prolonged DAPT has a clinical impact since it increases both bleeding risk (9,10). Furthermore, a series of interventions like endoscopic, dental, and surgical procedures are often delayed because of prolonged DAPT, thus affecting the patient’s quality of life (11). On the bases of all these considerations, determining the optimal (or minimal necessary) duration of DAPT is very important.