Shortened duration of DAPT after PCI and continuing with a P2Y12 inhibitor alone was associated with a similar rate of ischemic events but with less bleeding after 3 years of follow-up in the SMART-CHOICE trial. CardioTwitter MedTwitter
"The current results of extended follow-up from the SMART-CHOICE trial support evidence of aspirin dropping strategy with indefinite use of P2Y12 inhibitor after minimum use of DAPT in patients who underwent PCI," they say.
. For patients at higher risk of bleeding, even shorter DAPT durations can be considered on a case-by-case basis. The editorialists explain that the concept of P2Y12 inhibitor monotherapy is attractive because it may optimize antiplatelet effects through a single agent that can avoid the gastrointestinal toxicity of aspirin as well as the increased bleeding that comes with combing multiple antithrombotic agents.
"For patients at greatest risk for recurrent ischemic events, the role of continued DAPT is always an option, but these data give clinicians more options to pursue individualized treatment decisions," they write.
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