PracticeUpdate Cardiology June 2019

CONFERENCE COVERAGE 18

AmericanCollege of Cardiology Annual Scientific Session& Expo 2019 16–18 MARCH 2019 • NEW ORLEANS, LOUISIANA, USA Dual Antiplatelet Therapy After PCI With Drug-Eluting Stents Interview with Deepak L. Bhatt MD, MPH, FACC, FAHA, FSCAI, FESC by Aman Shah MD Dr. Bhatt is Executive Director of Interventional Cardiovascular

© ACC/Scott Morgan 2019

patient populations for whom you would con- sider 1 month, 3 months, or some populations where you may consider doing it for longer? Dr. Bhatt: There are a number of studies that are still going on examining shorter dura- tions of DAPT so I might wait until they’re complete before completely changing my practice, but I do think if a patient has an acute coronary syndrome, as the guide- lines currently recommend at least 12 months of DAPT are recommended for the ACS, not for the stent, per se, but for the ACS. So, it really has to do with the under- lying patient risk. Now, for someone with stable coronary artery disease, I think already the current guidelines say 6 months is sufficient, but I think these data give us some more reas- surance that if we have to stop early then maybe it is okay to stop it at 1 month or 3 months. So for example, if a patient is hav- ing lots of issues with bleeding, instead of torturing the patient, saying you’ve got to continue for 6 months or maybe even 12 months in the case of an ACS patient, there, it might make sense to say, okay, we can stop at a shorter time period, whether it’s, you know, 1 or 3 months.

Programs at Brigham and Women’s Hospital Heart & Vascular Center and Professor of Medicine at Harvard Medical School. He is also a Senior Physician at Brigham and Women’s Hospital and Senior Investigator in the TIMI Study Group.

rates have come down, maybe we can get away with shorter durations of DAPT. So, that was what was really studied here in these two trials. And indeed, the shorter durations of DAPT seem to be okay. You know, within the modest sample sizes here – well, I shouldn’t necessarily say modest, it’s a few thousand patients – there didn’t seem to be any decrement in efficacy or at least not a significant decrement in effi- cacy with the shorter durations of DAPT 1 or 3 months say versus 12, but there was more bleeding as one would expect with longer durations of DAPT versus shorter duration of DAPT. So it certainly shows in the carefully selected patients who got ran- domized into these trials that it’s possibly an acceptable strategy to go for a shorter duration of DAPT, at least as far as the stent was concerned. Dr. Shah: Okay, and so how would you imple- ment it in your practice? Are there specific

Dr. Shah: There are two trials that address the issue of drug-eluting stents and the duration of DAPT (dual antiplatelet therapy) after their implantation. Could you tell us about these SMART-CHOICE and STOP GAP trials? Dr. Bhatt: Absolutely. So, these are similar trials in some respects, looking at whether shorter durations of DAPT, or dual antiplate- let therapy, after stenting in the modern era with modern contemporary second-gener- ation drug-eluting stents is sufficient. That is, can you just go respectively in these two trials, 1 or 3 months of DAPT or do you need to go at least 12 months or more of DAPT? An important question, we’ve had several trials about DAPT duration, a little bit of dis- cordance between different trials, but for the most part, I’d say for ACS (acute coro- nary syndrome) patients, most of the trials have shown those patients that are get- ting stented, longer duration is better. But some have said well, with current gener- ation drug-eluting stents, stent thrombosis

Go to www.practiceupdate.com/c/81078 to watch this interview with Dr. Bhatt.

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