The aged debate goes on! How long should we be giving dual anti-platelet therapy (DAT) after DES? Current guidelines suggest 12 months….

This trial, in the NEJM March 15, 2010 attempts to answer this question.

2701 patients receiving DES in 2 trials (RAEL LATE and ZEST LATE) were randomised to DAT (clopidogrel and aspirin) vs aspirin alone. They had been free major CV events and bleeding in preceeding 12 months. End point MI or death (cardiac). The 2 trials were merged.

Essentially the cumulative risk of the primary outcome was 1.8% in DAT group vs 1.2% in the aspirin alone  group ie no significant difference. There was a trend towards harm for the composite endpoint of death, MI, stroke in the DAT group.

Warning!….this was 2 separate trials merged into one (due to slow recruitment). The enrollment criteria were slightly different and despite the merger the trial was still underpowered to detect differences in clinical outcomes between the 2 trials. The trial was in Asian patients (? results applicable in non-Asians as response to clopidogrel can vary in different ethnic groups) and used first generation DES.

So, a larger randomised trial in a more diverse population is now required…..Are we any further forwards in answering the question..probably not!