A new study confirms that dual antiplatelet therapy should be continued for at least 12 months after stent placement for acute coronary syndrome (heart attack) when there is no risk of excessive bleeding.
Study, presented at the 2018 annual meeting of the American College of Cardiology, confirms the need to continue to follow current recommendations on dual antiplatelet therapy in patients without risk of excessive bleeding who have received a stent for acute coronary syndrome : the double treatment must last at least 12 months. The latter consists of aspirin or clopidogrel or a similar drug such as ticagrelor.
The combined rate of death from any vascular cause (heart attack or stroke) within 18 months is not significantly different in patients on dual antiplatelet therapy for 6 months or at least 12 months after stenting. But patients who received this treatment for only 6 months are however twice as likely to have a heart attack than those who receive it for 12 months. In practice, patients who have already had a myocardial infarction are more likely to relapse after 6 months of treatment.
The SMART-DATE trial
The SMART-DATE trial included 2,712 patients with ACS who had had angioplasty. The latter were randomized to receive either dual platelet therapy for at least 12 months, or the same treatment but for 6 months followed by aspirin monotherapy for at least 6 additional months. The primary endpoint is the combined rate of death from any cause (heart attack or stroke) within 18 months of stent placement.
After 18 months, 63 patients (or 4.7%) of the patients in the group receiving treatment for 6 months and 56 patients (or 4.2%) in the group receiving treatment for 12 months had at least one cardiac event. .
On the other hand, the all-cause mortality rates are not significantly different in the two groups (2.6% in the group treated for 6 months against 2.9% in the group treated for 12 months).
Increased risk of heart attack with short treatment
However, the risk of myocardial infarction is 2.4 times higher in the group treated for 6 months, with infarctions occurring in 1.8% of patients in the group treated for 6 months against 0.8% in the group of patients under treatment for 12 months.
In addition, during the period between 6 and 18 months after stenting for patients in the group treated for 6 months only with aspirin, the risk of heart attack is 5.1 times higher in patients. patients treated for 6 months than in those treated for 12 months. However, patients in the group treated for 6 months also had an increased risk (by 69%) of death or of suffering from a heart attack or stroke.
Researchers indicate that in the short term, prolonged dual antiplatelet therapy is safe in patients with ACS who have been placed in a stent. The study will continue for up to 18 months.
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