Memahami Terapi Dual Antiplatelet setelah Percutaneous Coronary Intervention

Oleh :

dr. Hendra Gunawan SpPD

Terapi dual antiplatelet sering digunakan pada pasien dengan penyakit jantung koroner (PJK) setelah tindakan kateterisasi jantung atau Percutaneous Coronary Intervention (PCI). Tujuannya adalah untuk menurunkan risiko kejadian iskemik, termasuk thrombosis stent, infark miokard, stroke, hingga kematian akibat kejadian kardiovaskular. Regimen terapi dual antiplatelet yang direkomendasikan adalah kombinasi antara aspirin dengan satu agen inhibitor P2Y12 seperti clopidogrel, prasugrel, atau ticagrelor.[1]

Hingga kini, durasi dari terapi dual antiplatelet yang terbaik masih menjadi perdebatan. Di satu sisi, penggunaannya telah banyak dilaporkan bermanfaat sebagai pencegahan sekunder infark miokard dan thrombosis stent. Namun di sisi lain, penggunaannya juga berkaitan dengan peningkatan risiko perdarahan.[2]

Penggunaan Terapi Dual Antiplatelet

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Referensi

1. Costa F, Valgimigli M. The optimal duration of dual antiplatelet therapy after coronary stent implantation: to go too far is as bad as to fall short. Cardiovascular Diagnosis & Therapy. 2018;8(5):630-46.
2. Bagur R, Jolly SS. Dual Antiplatelet Therapy After Percutaneous Coronary Intervention. Circulation: Cardiovascular Interventions. 2018;11:e007368.
3. Capodanno D, Alfonso F, Levine GN, Valgimigli M, Angiolillo DJ. ACC/AHA Versus ESC Guidelines on Dual Antiplatelet Therapy. Journal of The American College of Cardiology. 2018;72(23 Pt A):2915-31.
4. Mauri L, Kereiakes DJ, Yeh RW, Driscoll-Shempp P, Cutlip DE, Steg PG, et al. DAPT Study Investigators. Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. New England Journal of Medicine. 2014;2014(371):2155-66.
5. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, et al. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. Circulation. 2016;134(10):e123-55.
6. Howard CE, Nambi V, Jneid H, Khalid U. Extended Duration of Dual‐Antiplatelet Therapy After Percutaneous Coronary Intervention: How Long Is Too Long? Journal of the American Heart Association. 2019;8:e012639
7. Deshpande NV, Admane P, Mardikar HM. Bleeding on dual antiplatelet therapy: real-life challenges. European Heart Journal Supplements. 2018;20(Suppl_B):B1-9.
8. Yeh RW, Secemsky EA, Kereiakes DJ, et al. DAPT Study Investigators. Development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention. JAMA, 2016; 315:1735–1749. doi: 10.1001/jama.2016.3775
9. Brener SJ, Kirtane AJ, Rinaldi MJ, et al. Prediction of ischemic and bleeding events using the dual antiplatelet therapy score in an unrestricted percutaneous coronary intervention population: analysis from the ADAPT-DES registry. Circ Cardiovasc Interv. 2018. 11:e006853. doi: 10.1161/CIRCINTERVENTIONS.118.006853
10. Yin Shang-He-Lin, Xu Peng, Wang Bian, Lu Yao, Wu Qiao-Yu, Zhou Meng-Li et al. Duration of dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent: systematic review and network meta-analysis BMJ 2019; 365 :l2