An update of dual antiplatelet therapy

Abstract

Since platelet activation and aggregation play a major role in thrombus formation in lumen of coronary arteries, they constitute a main target in treatment of stable ischemic heart disease and acute coronary syndromes. Antiplatelet therapy should be commenced as early as possible within the current indications in order to reduce the risk of both acute ischemic complications and recurrent atherothrombotic events. Platelet functions can be inhibited by three classes of drugs having different mechanisms of action, namely acetylsalicylic acid, P2Y12 inhibitors, and glycoprotein IIb/IIIa antagonists. Dual antiplatelet therapy (acetylsalicylic acid and P2Y12 inhibitors) have recently been a hot topic of research with the advent of stents in recent years. Multiple regimens of antiplatelet and anticoagulation therapy have been used in the past in patients undergoing percutaneous coronary intervention. The optimal duration of dual antiplatelet therapy after drug-eluting stent implantation is unclear. Many clinicians have pushed for prolonged dual antiplatelet therapy — beyond 12 months — on the assumption that extended therapy reduces recurrent cardiovascular events. Despite the established guidelines, there is not a clear consensus about how to manage antiplatelet therapy. New antiplatelet agents have been developed for patients at high risk of thrombosis. Their benefits in terms of mortality and major cardiovascular events have been demonstrated, but some concerns remain regarding the possible increase in bleeding.The aim of this review was to summarize the current literature containing the potential solutions to problems related to indications and duration of dual antiplatelet therapy and its interaction with other medications.