Dual Antiplatelet Therapy Duration in Acute Coronary Syndrome Patients: The State of the Art and Open Issues

Table 1

Characteristics of randomized studies comparing different durations of dual antiplatelet therapy.

Study	Antiplatelet treatment				ACS patients (n/N)	Primary efficacy endpoint	Primary efficacy result	Primary safety endpoint	Primary safety result
	Strategy shorter DAPT	Months	Strategy longer DAPT	Months
RESET	ASA + clopidogrel	3	ASA + clopidogrel	12	601/2117	Composite death from all-cause myocardial infarction or stent thrombosis	—	TIMI	—
ISAR-SAFE	ASA + clopidogrel	6	ASA + clopidogrel	12	1601/4000	Composite of death, myocardial infarction, stent thrombosis, stroke, or TIMI major bleedings	—	TIMI	—
DAPT STEMI	ASA + prasugrel, ticagrelor (preferred above clopidogrel)	6	ASA + prasugrel, ticagrelor (preferred above clopidogrel)	12	870/870	All-cause mortality, myocardial infarction, any revascularization, stroke, TIMI major bleeding	—	TIMI/BARC 3	—
I-LOVE-IT 2	ASA + clopidogrel	6	ASA + clopidogrel	12	1496/1829	Composite of cardiac death, target vessel myocardial infarction (TVMI), or clinically indicated target lesion revascularization (CI-TLR)	—	BARC 3–5	—
REDUCE	ASA + prasugrel, ticagrelor (preferred above clopidogrel)	3	ASA + prasugrel, ticagrelor (preferred above clopidogrel)	12	1496/1496	All-cause death, MI, ST, stroke, TVR, or bleeding	—	BARC 2–5	—
SMART DATE	ASA + any P2Y12 inhibitor	6	ASA + any P2Y12 inhibitor	12	1000/1297	A composite of all-cause mortality, myocardial infarction, and cerebrovascular events)	—	BARC 2–5	—
EXCELLENT	ASA + clopidogrel	6	ASA + clopidogrel	12	744/1443	Composite of cardiac death, myocardial infarction, or target vessel revascularization	—	TIMI	—
IVUS XL	ASA + clopidogrel	6	ASA + clopidogrel	12	687/1400	Composite of cardiac death, myocardial infarction, stroke, or TIMI major bleeding	—	TIMI	—
OPTIMIZE	ASA + clopidogrel	3	ASA + clopidogrel	12	996/3119	Composite of death from any cause, MI, stroke, or major bleeding	—	Intracranial, intraocular, or retroperitoneal hemorrhage; clinically overt blood loss resulting hemoglobin decrease >3 g/dL, any hemoglobin decrease >4 g/dL, or transfusion of 1 unit of packed red blood cells or whole blood; or intracranial hemorrhage or bleeding causing hemodynamic compromise and requiring intervention	—
SECURITY	ASA + any P2Y12 inhibitor	6	ASA + any P2Y12 inhibitor	12	442/1399	Composite of cardiac death, MI, stroke, definite or probable stent thrombosis or bleeding academic consortium criteria (BARC) type 3 or 5 bleeding	—	BARC 3–5	—
NIPPON	ASA + clopidogrel (prasugrel)	6	ASA + clopidogrel (prasugrel)	18	1079/3307	All-cause death, Q-wave or non-Q-wave MI, cerebrovascular events, and major bleeding events	—	Modified REPLACE-2 criteria	—
STOPDAPT 2	ASA + clopidogrel	1	ASA + clopidogrel	12	1140/3009	Composite of cardiac death, MI, stroke, definite or probable stent thrombosis or TIMI major/minor bleeding		TIMI
SMART CHOICE	ASA + any P2Y12 inhibitor	3	ASA + any P2Y12 inhibitor	12	1736/2993	All-cause death, MI, or stroke	—	BARC 2–5
DES LATE-DATE	ASA + clopidogrel	12	ASA + clopidogrel	24	3063/5045	Composite of death resulting from cardiac causes, myocardial infarction, or stroke	—	TIMI
ARCTIC interruption	ASA + clopidogrel (75 or 150 mg) or prasugrel	12	ASA + clopidogrel (75 or 150 mg) or prasugrel	24	323/1286	Any death, myocardial infarction, stent thrombosis, stroke, or TIA, urgent revascularization	—	STEEPLE	—
DAPT study	ASA + clopidogrel/prasugrel	12	ASA + clopidogrel/prasugrel	30	3576/9961	Stent thrombosis		GUSTO	—
Italic/italic+	ASA	6	ASA + clopidogrel (prasugrel, ticagrelor)	12	792/1850	Composite of death, MI, emergency TVR, stroke, or major bleeding	—	TIMI	—
TWILIGHT	ASA + ticagrelor (then ticagrelor)	3	ASA + ticagrelor	12	7119/7119	Death from any cause, nonfatal myocardial infarction, or nonfatal stroke	—	BARC 2, 3–5
GLOBAL LEADERS	ASA + ticagrelor (then ticagrelor)	1	ASA + ticagrelor or clopidogrel	12	7487/15968	All-cause mortality or new nonfatal, centrally adjudicated Q-wave MI	—	BARC 3–5