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Journal of Thrombosis and Thrombolysis

, Volume 46, Issue 4, pp 559–569 | Cite as

Lights and shadows of long-term dual antiplatelet therapy in “real life” clinical scenarios

  • Marino Scherillo
  • Plinio Cirillo
  • Dario Formigli
  • Giulio Bonzani
  • Paolo Calabrò
  • Paolo Capogrosso
  • Pio Caso
  • Giovanni Esposito
  • Rosario Farina
  • Paolo Golino
  • Tonino Lanzillo
  • Franco Mascia
  • Ciro Mauro
  • Federico Piscione
  • Girolamo Sibilio
  • Bernardino Tuccillo
  • Bruno Villari
  • Bruno Trimarco
Article
  • 81 Downloads

Abstract

Dual antiplatelet therapy (DAPT) is a cornerstone of treatment for patients with acute coronary syndromes (ACS). Mounting evidences have opened the debate about the optimal DAPT duration. Considering the ACS-pathophysiology, the most recent guidelines recommend DAPT in all ACS patients for at least 12 months unless there are contraindications such as excessive risk of bleeding. Thus, it can be considered acceptable earlier discontinuation if the risk of morbidity from bleeding outweighs the anticipated benefit. On the other hand, several studies have clearly indicated that a significant burden of platelet related-events, such as stroke and new ACS might occur after this period, suggesting that potential benefits might derive by prolonging DAPT beyond 12 months (Long DAPT). Indeed, although current guidelines give some indications about patients eligible for Long DAPT, they do not embrace several real-life clinical scenarios. Thus, in such scenarios, how to decide whether a patient is eligible for Long DAPT or not might be still challenging for clinicians. This position paper presents and discusses various “real-life” clinical scenarios in ACS patients, in order to propose several possible recommendations to overcome guidelines potential limitations.

Keywords

Acute coronary syndrome Antiplatelets DAPT Long-term DAPT Patient management 

Notes

Campania Study Group Faculty

Alessandro Bellis (Napoli), Gennaro Bellizzi (Ariano Irpino), Renatomaria Bianchi (Napoli), Giulio Bonzani (Napoli), Biagio Bosco (S.M. Capua Vetere), Gennaro Caiazzo (Aversa), Paolo Calabrò (Napoli), Luigi Caliendo (Nola),Paolo Capogrosso (Napoli), Nicola Capuano (Nocera Inferiore), Pio Caso (Napoli), Quirino Ciampi (Benevento), Giovanni Cimmino (Napoli), Ersilia Cipolletta (Giugliano), Plinio Cirillo (Napoli), Rosangela Cocchia (Nola), Antonino Coppola (Sorrento), Gregorio Covino (Napoli), Giovanni D’Angelo (Eboli), Giovanni De Caro (C/Mare di Stabia), Luigi Di Lorenzo (Sessa A.), Giovanni Esposito (Napoli), Nicolino Esposito (Napoli), Rosario Farina (Salerno), Dario Formigli (Benevento), Gennaro Galasso (Salerno), Paolo Golino (Caserta), Luigi Irace (Napoli), Tonino Lanzillo (Avellino), Raffaele Marcheggiano (Sessa A.), Franco Mascia (Caserta), Ciro Mauro (Napoli), Raffaele Merenda (Napoli), Giovanni Napolitano (Giugliano), Fabio Pastore (Eboli), Francesco Piemonte (Frattamaggiore), Orlando Piro (Napoli), Federico Piscione (Salerno), Raffaele Sangiuolo (Napoli), Aniello Sansone (Ischia), Marino Scherillo (Benevento), Girolamo Sibilio (Pozzuoli), Bruno Trimarco (Napoli), Bernardino Tuccillo (Napoli), Alfredo Vetrano (Caserta), Bruno Villari (Benevento).

Document Reviewers

Dario Formigli (Benevento), Plinio Cirillo (Napoli).

Author contributions

All authors contributed to (1) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data, (2) drafting of the article or revising it critically for important intellectual content, and (3) final approval of the version to be published. MS, PC, and DF are the coordinators of the study group.

Compliance with ethical standards

Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Marino Scherillo
    • 1
  • Plinio Cirillo
    • 2
  • Dario Formigli
    • 1
  • Giulio Bonzani
    • 3
  • Paolo Calabrò
    • 4
  • Paolo Capogrosso
    • 5
  • Pio Caso
    • 6
  • Giovanni Esposito
    • 2
  • Rosario Farina
    • 7
  • Paolo Golino
    • 4
  • Tonino Lanzillo
    • 8
  • Franco Mascia
    • 9
  • Ciro Mauro
    • 10
  • Federico Piscione
    • 11
  • Girolamo Sibilio
    • 12
  • Bernardino Tuccillo
    • 13
  • Bruno Villari
    • 14
  • Bruno Trimarco
    • 2
  1. 1.U.O.C. Cardiologia Interventistica ed UTIC, Azienda Ospedaliera “G.Rummo” di BeneventoNapoliItaly
  2. 2.Division of Cardiology, Department of Advanced Biomedical SciencesUniversita` di Napoli “Federico II”NapoliItaly
  3. 3.U.O.C. Cardiologia Interventistica, Azienda Ospedaliera Specialistica dei ColliNapoliItaly
  4. 4.Department of Cardio-Thoracic and Respiratory SciencesUniversità degli Studi della Campania “Luigi Vanvitelli”CasertaItaly
  5. 5.U.O.C. Cardiologia ed UTIC, Ospedale San Giovanni BoscoNapoliItaly
  6. 6.U.O.C., AORN dei Colli-MonaldiNapoliItaly
  7. 7.Cardiologia ed UTIC, Azienda Ospedaliera Universitaria San Giovanni di Dio ed Ruggi d’AragonaSalernoItaly
  8. 8.U.O.C. Cardiologia ed UTIC, Ospedale MoscatiAvellinoItaly
  9. 9.U.O.C. Cardiologia-UTIC, Ospedale S. Anna e S. SebastianoCasertaItaly
  10. 10.U.O.C. Cardiologia con UTIC, AORN Antonio CardarelliNapoliItaly
  11. 11.U.O.C. Cardiologia Preventiva Azienda Ospedaliera Universitaria San Giovanni di Dio ed Ruggi d’AragonaSalernoItaly
  12. 12.U.O.C. Cardiologia UTIC, Ospedale Santa Maria delle GraziePozzuoliItaly
  13. 13.U.O.C. Cardiologia Interventistica ed UTIC, Ospedale Loreto MareNapoliItaly
  14. 14.Cardiologia, Ospedale Sacro Cuore di Gesu’BeneventoItaly

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