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  • Editorial: Risk of Being Bitten by the Cat or Dog and How Risk Scores Can Help

    Dual antiplatelet therapy (DAPT) is the cornerstone of treatment after coronary stenting for preventing thrombotic complications like stent thrombosis and myocardial infarction. In the era of bare metal stents, life was simple and 1 month of DAPT post-stenting was standard and considered safe and enough. Things became more complex the moment the first drug-eluting stents (DES) entered clinical practice in 2002 in Europe and 2003 in the USA. Instructions for use of the first-generation sirolimus-eluting Cypher stent and the paclitaxel-eluting Taxus stent mentioned 3 and 6 months of DAPT post-stenting, respectively. Why exactly 3 and 6 months? I don't know exactly, but initial intravascular ultrasound studies with the first-generation DES showed delayed coverage of the stent struts  , and these DAPT periods were felt safe, until the first reports on very late stent thrombosis with DES came out and the “firestorm” at the European Society of Cardiology 2006 congress happened. Based on the suspicion of increased risk of death and myocardial infarction with the first-generation DES compared to bare metal stents, the US Food and Drug Administration and the Science Advisory panel from the American Heart Association/American College of Cardiology/Society for Cardiovascular Angiography and Interventions recommended a 12-month DAPT duration after DES and a strong recommendation not to stop DAPT prematurely.

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