Medicine by the Numbers

A Collaboration of TheNNT.com and AFP

Prolonged Dual Antiplatelet Therapy After MI Reduces Major Adverse Cardiac Events

 

Am Fam Physician. 2017 Oct 1;96(7):online.

image

 Enlarge     Print

PROLONGED DAPT AFTER MYOCARDIAL INFARCTION REDUCES MAJOR ADVERSE CARDIAC EVENTS

BenefitsHarms

63 patients treated with DAPT to prevent one major adverse cardiac event

None experienced an additional major bleeding complication

219 patients treated with DAPT to prevent one cardiovascular death


DAPT = dual antiplatelet therapy.

PROLONGED DAPT AFTER MYOCARDIAL INFARCTION REDUCES MAJOR ADVERSE CARDIAC EVENTS

BenefitsHarms

63 patients treated with DAPT to prevent one major adverse cardiac event

None experienced an additional major bleeding complication

219 patients treated with DAPT to prevent one cardiovascular death


DAPT = dual antiplatelet therapy.

Details for This Review

Study Population: Adults with stent implantation following myocardial infarction (MI) and concurrent treatment with dual antiplatelet therapy (DAPT)—the combination of aspirin and a P2Y12 inhibitor

Efficacy End Points: Prevention of major adverse cardiac events, defined as cardiovascular and noncardiovascular death, MI, and stroke

Harm End Points: Major bleeding complications

Narrative: More than 1 million Americans are diagnosed with an MI every year.1 Risk of atherothrombosis increases significantly after an MI, with an increase in platelet activation that can last for years.1 Frequent placement of drug-eluting stents in these patients further increases the risk of thrombosis. Because of this increased thrombotic risk, DAPT is used for long-term secondary prevention of major cardiac events.24 The duration of DAPT has been debated over the past few years. Prolonged (more than 12 months) DAPT has been shown to increase mortality in patients with drug-eluting stents despite a reduced rate of MI and stent thrombosis.5 However, recent studies suggest that the use of prolonged DAPT after an MI, regardless of stent placement or type, improves cardiovascular mortality without a significant increase in bleeding risk.5

A 2016 meta-analysis, including three randomized controlled trials with a total of 21,534 patients post-MI, compared those who received DAPT for 12 months and those who received continuous treatment beyond one year, with mean follow-up of 2.5 years.5 Patients were randomized at least

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Mozaffarian D, Benjamin EJ, Go AS, et al. Executive summary: heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133(4):447–454....

2. Udell JA, Bonaca MP, Collet JP, et al. Long-term dual antiplatelet therapy for secondary prevention of cardiovascular events in the subgroup of patients with previous myocardial infarction: a collaborative meta-analysis of randomized trials. Eur Heart J. 2016;37(4):390–399.

3. Bonaca MP, Bhatt DL, Cohen M, et al.; PEGASUS-TIMI 54 Steering Committee and Investigators. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med. 2015;372(19):1791–1800.

4. Bittl JA, Baber U, Bradley SM, Wijeysundera DN. Duration of dual antiplatelet therapy: a systematic review for the 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2016;68(10):1116–1139.

5. Patti G, Cavallari I. Extended duration dual antiplatelet therapy in patients with myocardial infarction: a study-level meta-analysis of controlled randomized trials. Am Heart J. 2016;176:36–43.

 

 

Copyright © 2017 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

MOST RECENT ISSUE


Oct 15, 2017

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article