Academic Activity Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Aug 26, 2021; 13(8): 243-253
Published online Aug 26, 2021. doi: 10.4330/wjc.v13.i8.243
Shortened dual antiplatelet therapy in contemporary percutaneous coronary intervention era
Jennie Han, Nadeem Attar
Jennie Han, Nadeem Attar, Department of Cardiology, Royal Lancaster Infirmary, Lancaster LA1 4RP, Lancashire, United Kingdom
Nadeem Attar, Department of Cardiology, Blackpool Victoria Hospital, Blackpool FY3 8NR, Lancas, United Kingdom
Author contributions: Attar N and Han J wrote the review article after extensive review of literature.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Jennie Han, BM BCh, Doctor, Research Fellow, Department of Cardiology, Royal Lancaster Infirmary, Ashton Road, Lancaster LA1 4RP, Lancashire, United Kingdom.
Received: March 15, 2021
Peer-review started: March 15, 2021
First decision: April 26, 2021
Revised: May 19, 2021
Accepted: July 26, 2021
Article in press: July 26, 2021
Published online: August 26, 2021

Percutaneous coronary intervention with stenting is followed by a duration of dual antiplatelet therapy (DAPT) to reduce stent thrombosis and avoid target lesion failure. The period of DAPT recommended in international guidelines following drug-eluting stent implantation is 12 mo for most patients with acute coronary syndrome, and 6 mo for patients with chronic coronary syndrome or high bleeding risk. The new generation of drug-eluting stents have metallic platforms with thinner struts, associated with significantly less stent thrombosis. Shortened DAPT has been investigated with these stents, with evidence from randomised clinical trials for some individual stents showing non-inferior safety and efficacy outcomes. This has to be balanced by the effect of DAPT on secondary prevention of systemic cardiovascular disease especially in high-risk populations. This review will outline the current evidence for individual stents with regards to DAPT duration for both acute coronary syndrome and chronic coronary syndrome and discuss further directions for research and personalised medicine in this contemporary percutaneous coronary intervention era.

Keywords: Coronary artery disease, Drug-eluting stent, Percutaneous coronary intervention, Dual antiplatelet therapy, Stent thrombosis, Target lesion revascularization

Core Tip: The new generation of drug-eluting stents have different properties such as reduced strut thickness allowing lower level of local stent thrombosis, which may be feasible with shortened dual antiplatelet therapy (DAPT). Only a small number of individual stents have been validated for reduced DAPT, such as 1 mo for the BioFreedom stainless steel biolimus-eluting stent and the Onyx Resolute cobalt-chromium zotarolimus-eluting stent but in only certain populations. Future trials will compare DAPT durations within the same stent. Future research should also examine risk stratification and the parameters for patients to benefit the most from shortened DAPT.