Expert position paper on prolonged dual antiplatelet therapy in secondary prevention following myocardial infarction
The protective effect of dual antiplatelet therapy (DAPT) following acute coronary syndrome is undisputed, but its duration is subject of debate. Several studies show that prolonged therapy provides a clinical benefit in patients following acute coronary syndrome. The aim of this position paper authored by Austrian experts is to outline the current evidence and provide an overview of recent studies. It is also intended to serve as a practical guide to identify those patients who may benefit from prolonged DAPT.
Platelet activation and aggregation with consecutive thrombus formation are key elements in the pathophysiology of ischaemic cardiovascular events. Oral antiplatelet therapy is therefore a central measure in the management of acute coronary syndrome (ACS) and in the secondary prevention of cardiovascular events.
International guidelines on the management of non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI) recommend immediate therapy with acetylsalicylic acid (ASA) and a P2Y12inhibitor, both in patients who are undergoing conservative treatment and in patients undergoing interventional treatment. This dual antiplatelet therapy (DAPT) is to be continued for at least 12 months. Tab. 1 provides an overview of the current guidelines.