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Outcomes with increased length of dual antiplatelet therapy after PCI
The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is uncertain. Although observational studies have suggested DAPT for longer than a year post-PCI reduces ischemic events, other studies suggest longer durations of DAPT confer no benefits despite increased bleeding risk. This randomized controlled trial evaluated patient outcomes with 12-months vs 30-months of DAPT after PCI. A total of 22,866 patients after PCI with a drug-eluting stent (approximately 40% in the context of an ACS) were enrolled. After 12 months of standard DAPT (with either clopidogrel or prasugrel alongside aspirin) a total of 9961 patients who had tolerated DAPT without complications and who had not undergone any further procedures were randomly assigned to continue receiving DAPT treatment or to aspirin and placebo for an additional 18 months. The co-primary end-point was stent thrombosis and major adverse cardiovascular events (MACE) with a primary safety end-point of moderate or severe bleeding. Long-term continuation of DAPT significantly reduced the rate of stent thrombosis (0.4% vs. 1.4%; HR, 0.29 [95% CI, 0.17 to 0.48]; P<0.001) and MACE (4.3% vs. 5.9%; HR, 0.71 [95% CI, 0.59 to 0.85]; P<0.001) …
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