News | January 07, 2015

Recent Cardiovascular Clinical Trials Framing Debate on Personalized Treatment, says GlobalData Analyst

Study revealed treatment with dual antiplatelet therapy decreased risk of stent thrombosis and major cardiovascular and cerebrovascular events

January 7, 2015 — Discussions regarding late-breaking cardiovascular clinical trials among leading medical scientists are placing considerable emphasis on individualized patient care, particularly in the area of dual antiplatelet therapy, according to an analyst with research and consulting firm GlobalData.

At the 2014 American Heart Association (AHA) meeting in Chicago, the results of the Dual Antiplatelet Therapy (DAPT) Study played a central role in presentations and debates regarding the use of antiplatelet blood-thinning agents.

Eric J. Dimise, Ph.D., GlobalData’s analyst covering Cardiovascular & Metabolic Disorders, states that the DAPT Study attempted to address an outstanding question concerning how long physicians should apply dual antiplatelet therapy following implantation of a drug-eluting stent (DES), with leading investigators concluding that the solution may depend upon individual patient needs.

Dimise says: “The study revealed that treatment with dual antiplatelet therapy (aspirin and clopidogrel or prasugrel) decreased the risk of stent thrombosis and major cardiovascular and cerebrovascular events, compared to treatment with aspirin alone during the 12 to 30-month period following implantation of a DES. However, this was achieved at the price of an increased frequency of bleeding.

“As a consequence, the debate now focuses on how physicians should strike a balance between reducing cardiovascular events while simultaneously minimizing bleeding risk.”

According to the analyst, it has been proposed that one should err on the side of short-term therapy for patients at high risk of bleeding, while therapy beyond 12 months should be considered for those at high risk of a recurrent ischemic event.

However, cases have been presented in favor of both short and long-term therapies, with the former leaning on the resultant diminution of bleeding events observed in the placebo group of the DAPT Study, and the latter arguing for the clear cardiovascular event-reduction benefit.

Dimise comments: “While some disagreements remain, there is a general consensus that individualization of therapy is likely to become the new norm, and that further studies should be conducted to help clarify which patient subpopulations would reap the most benefit from long and short-term therapy.”

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