Dual antiplatelet therapy consisting of aspirin and a P2Y12 inhibitor is the main medical therapy for optimizing stent-related outcomes after PCI, concluded a review published today in JAMA. For the study, Emmanouil S. Brilakis, MD, PhD, and fellow researchers from the University of Texas Southwestern Medical Center at Dallas conducted a review of 91 publications (from the 6,852 retrieved) from 2000 to February 2013 that assessed optimal medical therapy after PCI.
They found that DAPT with aspirin and a P2Y12 inhibitor (eg, ticlopidine, clopidogrel [Plavix, Sanofi-Aventis], prasugrel [Effient, Daiichi Sankyo/Eli Lilly] and ticagrelor [Brilinta, AstraZeneca]) reduced the risk of stent thrombosis and subsequent CV events following PCI (number needed to treat, 33-53).
According to their findings, aspirin should be continued indefinitely and low doses (75-100 mg daily, usually 81 mg) is preferred over higher doses because of similar efficacy and higher bleeding risk with higher doses; this is a class IIA recommendation after PCI. A P2Y12 inhibitor should also be given for 12 months after PCI, unless the patient is at high risk for bleeding, although ongoing studies may result in a change to this recommendation.
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