What Pharmacists Need to Know About Post-Stent DAPT

Do you know the current guidelines for using dual antiplatelet therapy (DAPT) after drug-eluting stent implantation?

Christopher Betz, PharmD, BCPS, FKSHP, FASHP, a professor at the Sullivan University College of Pharmacy, and Snehal H. Bhatt, PharmD, BCPS, an associate professor at MCPHS University, presented a session on this topic at the 2015 American Society of Health-System Pharmacists (ASHP) Midyear meeting.

Among the many studies Drs. Betz and Bhatt reviewed was the CURE trial, which found that clopidogrel was associated with a 20% relative risk reduction in the primary endpoints of cardiovascular death, myocardial infarction, and stroke.

Dr. Bhatt noted that the relative risk reduction was largely driven by the decrease in myocardial infarction, specifically. He also cited that the CURE trial found major bleeding increased by 38%—a fact that sometimes goes overlooked, he said.

Another trial the presenters reviewed was PEGASUS, which involved patients with a history of myocardial infarction who were taking only acetylsalicylic acid.

Those who added 60 mg of ticagrelor to their current medication regimen saw reduced recurrent myocardial infarction, reduced stroke, and increased major bleeding.

Dr. Betz also provided an overview of what the clinical guidelines say about duration of DAPT.

Per the ST-elevation myocardial infarction (STEMI) guidelines, P2Y12 platelet inhibitor therapy should be given for 1 year to patients with STEMI treated with coronary stents during primary percutaneous coronary intervention (PCI) using clopidogrel 75 mg daily, prasugrel 10 mg daily, or ticagrelor 90 mg twice a day.

A P2Y12 platelet inhibitor for more than 1 year can be considered for patients undergoing drug-eluting stent placement.

According to the non—ST-segment elevation myocardial infarction (NSTEMI) guidelines, P2Y12 platelet inhibitor therapy should be given for at least 1 year to post-PCI patients treated with coronary stents using either clopidogrel 75 mg daily, prasugrel 10 mg daily, or ticagrelor 90 mg twice a day.

In addition, P2Y12 platelet inhibitor therapy should be given for up to 1 year in patients who do not receive coronary stents using either clopidogrel 75 mg daily or ticagrelor 90 mg twice a day.

A P2Y12 platelet inhibitor could be considered for longer than a year in patients undergoing stent implementation.

Meanwhile, PCI guidelines recommend that P2Y12 platelet inhibitor therapy should be given for at least 1 year to post-PCI patients treated with coronary stents for acute coronary syndrome (ACS) with clopidogrel 75 mg daily, prasugrel 10 mg daily, or ticagrelor 90 mg twice a day.

In addition, clopidogrel should given to patients receiving drugâ€Â