Source:Levine GN. Balancing Ischemic and Bleeding Risks of Prolonged Dual Antiplatelet Therapy. JAMA.2017;318(2):194-195. doi:10.1001/jama.2017.6698
Dual antiplatelet therapy (DAPT) combines aspirin with a P1Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor) to decrease the risk of coronary thrombosis. [start-highlighting]Compared with antiplatelet therapy with aspirin alone, DAPT after a myocardial infarction (MI) or percutaneous coronary intervention (PCI) reduces the risk of spontaneous MI and coronary stent thrombosis[end-highlighting] (Audio).1However, the addition, intensification, or prolongation of antiplatelet therapy necessitates a trade-off between decreasing ischemic risk and increasing bleeding risk.1 In addition to this trade-off, consideration also must be given to the implications of ischemic or bleeding events, how patients are selected for treatment with DAPT and its duration, and what can be done to reduce bleeding risk.