Long-Term DAPT For Secondary Prevention of CV Events in Patients With Previous MI
In patients with prior myocardial infarction (MI) at low risk of bleeding, continuation of dual antiplatelet therapy (DAPT) beyond a year offers a substantial reduction in important cardiovascular outcomes, including cardiovascular death, according to research presented by Jacob A. Udell, MD, MPH, as part of ESC Congress 2015 in London, and simultaneously published in the European Heart Journal.
Using a meta-analysis of seven recent clinical trials evaluating prolonged DAPT following a MI, Udell and his fellow investigators found long-term DAPT reduced cardiovascular risk compared to aspirin alone.
Specifically, extended DAPT for more than one year among stabilized high-risk patients with previous MI, decreased the composite risk of cardiovascular death, MI, or stroke, as well as stroke and cardiovascular death alone. Udell did note an increased risk of major bleeding in the DAPT group (1.9 percent vs. 1.1 percent), but there was no significant difference in fatal bleeding or intracranial hemorrhage between the two groups. Additionally, no excess of non-cardiovascular causes of death was observed and the effect of extended DAPT remained consistent irrespective of DAPT regimen, time from MI, ST-elevation or percutaneous coronary intervention status.
According to Udell, the study findings show that patients that derived benefit from extended DAPT included those at high risk (one to three years post-MI with additional cardiovascular risk factors) and those at low bleeding risk (no anticoagulation, recent bleeding or surgery, or history of intracranial hemorrhage). He cautioned that very few patients in the study had prior stroke and that more research is needed in this area.
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