How long should dual antiplatelet therapy be used in diabetic patients after implantation of drug-eluting stents?

PURPOSE OF REVIEW: To analyze evidence from randomized clinical trials (RCTs) that identifies the optimal duration of dual antiplatelet therapy (DAPT) after implantation of newer generation drug-eluting stents (DESs) in diabetic patients.

RECENT FINDINGS: Patients with diabetes mellitus have increased risk of ischemic events and bleeding after DES implantation. The optimal duration of DAPT for this population is currently unknown. In a subgroup analysis of 8542 diabetic patients enrolled in eight RCTs of DAPT duration after implantation of newer generation DESs, prolonged courses of DAPT of 12-36 months in duration resulted in rates of major adverse cardiac events that were no different from those seen after shorter courses of DAPT of 3-12 months in duration (odds ratio 1.00, 95% Bayesian credible interval 0.74-1.33).

SUMMARY: Prolonged DAPT up to 36 months after newer generation DES implantation in diabetic subgroups has not been associated with better outcomes than shorter courses of 3-12 months. Until dedicated trials are completed in diabetic populations, DAPT duration after newer generation DES implantation in patients with diabetes mellitus should follow recommendations for the general population.