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Comment & Response
April 9, 2014

Dual Antiplatelet Therapy After Stent Implantation—Reply

Author Affiliations
  • 1Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil
  • 2Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
JAMA. 2014;311(14):1446-1447. doi:10.1001/jama.2014.2107

In Reply The OPTIMIZE trial is the largest randomized trial published to date comparing short- vs long-term dual antiplatelet therapy after percutaneous coronary intervention. It was not meant to compare first- vs second-generation drug-eluting stents but rather to investigate the safety and efficacy of 3 vs 12 months of dual antiplatelet therapy with a second-generation drug-eluting stent. Over the past few years, several issues related to the duration of dual antiplatelet therapy have been studied and discussed in different clinical scenarios,1 which reflects the complexity of primary and secondary prevention of cardiovascular disease in daily clinical practice. However, in the context of percutaneous coronary intervention, there is substantial evidence demonstrating dissimilar vascular responses to different stent types, with significant implications for long-term safety.2,3 In fact, stent type alone was the single factor responsible for a change in guideline recommendations to prolong dual antiplatelet therapy.4 Thus, it appeared reasonable to perform a study comparing different dual antiplatelet therapy regimens using a second-generation drug-eluting stent.

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