In a recently released guideline released by a task for of the American College of Cardiology and the American Heart Association task force on clinical practice guidelines offered updated guidelines on duration of dual anti-platelet therapy in patients with coronary artery disease. The guidelines now support prescribing six months —not 12 months—of DAPT after newer generation DES implantation for many patients.

Stents are metal scaffolds used to ‘prop open’ narrowed arteries, a procedure commonly referred to as angioplasty with stent placement. Three broad categories of stents are currently being used in the U.S. — metal stents (BMS) and medicated metal stents (drug-eluting stents). Newer bioabsorable vascular scaffolds (BVS) are currently not approved in the U.S. After placement of these stents, 2 anti-platelet medications (dual anti-platelet agents [DAPT]), namely aspirin with clopidogrel, ticagrelor or prasugrel, are used to keep clots from forming on these stents and re-blocking the arteries.

This might include patients at higher risk for bleeding or those who require procedures or operations within 12 months.

Another randomized DAPT study published recently, on the other hand, suggested that up to 18 months of DAPT provided additional benefits in reducing stent clotting (thrombosis) and other major cardiac events.

Longer-term DAPT may be suitable for patients at low bleeding risk but who have diabetes mellitus, current cigarette use, prior stents in native or bypass grafts, presentation with or prior heart attack, congestive heart failure, and smaller stent diameter. Based on these data, it is imperative that patients with heart disease and stents discuss appropriate treatment, duration and risk with their physicians especially in regards to anti-platelet therapy.

CardioVisual is an excellent tool to enhance understanding about stent procedures. Doctors can use the app in clinic to explain stent procedures to patients, and then patients can review the material again, at home.