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How long should dual antiplatelet therapy be used in diabetic patients after implantation of drug-eluting stents?

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Purpose of review

To analyze evidence from randomized clinical trials (RCTs) that identifies the optimal duration of dual antiplatelet therapy (DAPT) after implantation of newer generation drug-eluting stents (DESs) in diabetic patients.

Recent findings

Patients with diabetes mellitus have increased risk of ischemic events and bleeding after DES implantation. The optimal duration of DAPT for this population is currently unknown. In a subgroup analysis of 8542 diabetic patients enrolled in eight RCTs of DAPT duration after implantation of newer generation DESs, prolonged courses of DAPT of 12–36 months in duration resulted in rates of major adverse cardiac events that were no different from those seen after shorter courses of DAPT of 3–12 months in duration (odds ratio 1.00, 95% Bayesian credible interval 0.74–1.33).Summary

Prolonged DAPT up to 36 months after newer generation DES implantation in diabetic subgroups has not been associated with better outcomes than shorter courses of 3–12 months. Until dedicated trials are completed in diabetic populations, DAPT duration after newer generation DES implantation in patients with diabetes mellitus should follow recommendations for the general population.
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Keywords: antiplatelet therapy; diabetes mellitus; hemorrhage; percutaneous coronary intervention; randomized controlled trials

Document Type: Research Article

Affiliations: Munroe Heart and Vascular Institute, Munroe Regional Medical Center, Ocala, Florida, USA

Publication date: November 1, 2016

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