Background and importance According to the 2017 updated guidelines from the European Society of Cardiology on dual antiplatelet therapy (DAPT), the optimal duration of DAPT remains a controversial topic. The decision must be dynamic and re-evaluated during the course of treatment. Hence it is essential that patients must be monitored in order to avoid coronary complications but also to prevent bleeding risk.
Aim and objectives To identify patients with long term DAPT, their indications and clinical conditions, and to evaluate bleeding risk. To explore if a pharmaceutical intervention, to adapt therapy duration according to the guidelines, is needed.
Material and methods A cross sectional descriptive study was conducted. We used a corporate business intelligence tool to identify patients ≥75 years of age on DAPT (a combination of aspirin plus platelet P2Y12 receptor blocker) for more than 3 years and without monitoring by the cardiologist during the last year. We recorded data on: (1) clinical context—acute coronary syndrome (ACS) and stable coronary disease after percutaneous coronary intervention (PCI); (2) indications for long term DAPT—prior myocardial infarction, prior stent thrombosis and multivessel PCI; (3) bleeding risk (PRECISE-DAPT score).
Results Seventy-four patients (64.9% men; mean (SD) age 84 (5.86) years) were included in the analysis. The clinical condition for DAPT indications were 82.4% stable coronary disease after PCI, 9.5% ACS and 8.1% patients with high risk cardioembolic stroke. The reason for a longer duration were: 55% multivessel PCI; 23% previous myocardial infarction; and 18.9% past history of stent thrombosis. The PRECISE-DAPT score was calculated in 49 patients: in 81.6% the score was ≥25 which could imply a high bleeding risk.
Conclusion and relevance The duration of DAPT therapy was longer than the recommended guidelines in a considerable number of patients. Most patients received DAPT after PCI with stent implantation. The value of the PRECISE DAPT score was above the recommended cut-off point. Pharmacist intervention with cardiologists and general practitioners may be necessary to avoid long term DAPT if patient safety is not improving.
References and/or acknowledgements No conflict of interest.
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