In the DAPT study, patients who tolerated 12 months of dual antiplatelet therapy after drug-eluting stent implantation were randomized to continue thienopyridine plus aspirin or aspirin alone. The principal findings were:

• A Continued thienopyridine increased both ischemic and bleeding events, so it was abandoned
• B Continued thienopyridine reduced stent thrombosis and major adverse cardiac events but increased bleeding ✓
• C Continued thienopyridine reduced bleeding but increased stent thrombosis
• D There was no difference in stent thrombosis, major adverse events or bleeding between arms

Explanation

The DAPT trial demonstrated that extending a thienopyridine beyond 12 months after drug-eluting stenting lowered late stent thrombosis and major adverse cardiac and cerebrovascular events, at the price of significantly more moderate or severe bleeding. The clinical implication is individualized continuation in patients at high ischemic and low bleeding risk. The most tempting distractor claims no benefit, but stent thrombosis was clearly halved with prolonged therapy.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.