Lights and shadows of long-term dual antiplatelet therapy in “real life” clinical scenarios
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Dual antiplatelet therapy (DAPT) is a cornerstone of treatment for patients with acute coronary syndromes (ACS). Mounting evidences have opened the debate about the optimal DAPT duration. Considering the ACS-pathophysiology, the most recent guidelines recommend DAPT in all ACS patients for at least 12 months unless there are contraindications such as excessive risk of bleeding. Thus, it can be considered acceptable earlier discontinuation if the risk of morbidity from bleeding outweighs the anticipated benefit. On the other hand, several studies have clearly indicated that a significant burden of platelet related-events, such as stroke and new ACS might occur after this period, suggesting that potential benefits might derive by prolonging DAPT beyond 12 months (Long DAPT). Indeed, although current guidelines give some indications about patients eligible for Long DAPT, they do not embrace several real-life clinical scenarios. Thus, in such scenarios, how to decide whether a patient is eligible for Long DAPT or not might be still challenging for clinicians. This position paper presents and discusses various “real-life” clinical scenarios in ACS patients, in order to propose several possible recommendations to overcome guidelines potential limitations.
KeywordsAcute coronary syndrome Antiplatelets DAPT Long-term DAPT Patient management
Campania Study Group Faculty
Alessandro Bellis (Napoli), Gennaro Bellizzi (Ariano Irpino), Renatomaria Bianchi (Napoli), Giulio Bonzani (Napoli), Biagio Bosco (S.M. Capua Vetere), Gennaro Caiazzo (Aversa), Paolo Calabrò (Napoli), Luigi Caliendo (Nola),Paolo Capogrosso (Napoli), Nicola Capuano (Nocera Inferiore), Pio Caso (Napoli), Quirino Ciampi (Benevento), Giovanni Cimmino (Napoli), Ersilia Cipolletta (Giugliano), Plinio Cirillo (Napoli), Rosangela Cocchia (Nola), Antonino Coppola (Sorrento), Gregorio Covino (Napoli), Giovanni D’Angelo (Eboli), Giovanni De Caro (C/Mare di Stabia), Luigi Di Lorenzo (Sessa A.), Giovanni Esposito (Napoli), Nicolino Esposito (Napoli), Rosario Farina (Salerno), Dario Formigli (Benevento), Gennaro Galasso (Salerno), Paolo Golino (Caserta), Luigi Irace (Napoli), Tonino Lanzillo (Avellino), Raffaele Marcheggiano (Sessa A.), Franco Mascia (Caserta), Ciro Mauro (Napoli), Raffaele Merenda (Napoli), Giovanni Napolitano (Giugliano), Fabio Pastore (Eboli), Francesco Piemonte (Frattamaggiore), Orlando Piro (Napoli), Federico Piscione (Salerno), Raffaele Sangiuolo (Napoli), Aniello Sansone (Ischia), Marino Scherillo (Benevento), Girolamo Sibilio (Pozzuoli), Bruno Trimarco (Napoli), Bernardino Tuccillo (Napoli), Alfredo Vetrano (Caserta), Bruno Villari (Benevento).
Dario Formigli (Benevento), Plinio Cirillo (Napoli).
All authors contributed to (1) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data, (2) drafting of the article or revising it critically for important intellectual content, and (3) final approval of the version to be published. MS, PC, and DF are the coordinators of the study group.
Compliance with ethical standards
Conflict of interest
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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