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Nov 12

DAPT Update

In short term 98% patients stick to dual antiplatelet therapy.  At 30 days not adhering to DAPT is associated with an increased risk (six fold greater)of stent thrombosis. 30 days adherence is important as 80% of the patients are on a second-generation drug-eluting stent, said Dr Roxana Mehran, of Mount Sinai School of Medicine in New York, and colleagues in a large, multicenter registry study.

Current ACC/AHA guidelines recommend DAPT for 30 days after placement of a bare metal stent and for one year after implantation of a DES.

The 30-day findings is the first report from the PARIS registry, an observational study that followed 5,033 patients in 15 centers in five countries for 24 months after stent implantation.

Non adherence can be

  1. Discontinuation (patients stopping treatment because their physician recommended it): 69%
  2. Interruption (hiatus of therapy recommended by the clinician that lasted no longer than 14 days) 19%
  3. Disruption (noncompliance, bleeding, or using lower levels of the therapy than prescribed): 12%

Disruption was mainly due to noncompliance and bleeding, while interruption was mostly due to surgery or medical procedures. Non-adherence was associated with higher rates of both ischemic and bleeding events at 30 days, including death, MI, definite/probable stent thrombosis, target vessel revascularization, and bleeding. The stent thrombosis rate in the adherent population was 0.46% compared with 2.9% in the non-adherent population, which equated to a 6.3-fold increased likelihood of thrombosis.
(Source: excerpts from MedPage Today)

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