Adherence to dual antiplatelet therapy after percutaneous coronary artery angioplasty

Abstract

Introduction: Percutaneous coronary intervention (PCI) is a treatment option in the management of coronary syndromes, either acute or chronic. Administration of dual antiplatelet therapy (DAPT) is essential in optimizing patients’ clinical outcomes after PCI and reducing the risk of stent thrombosis or ischemic events.
The aim of the present study was to review the literature regarding adherence to DAPT among patients undergoing PCI.
Methodology: A literature search of scientific articles was conducted in the electronic databases PubMed and Scopus with publication dates during last 5 years. The keywords used for the search were: Percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT), adherence as well as synonyms and combinations of the terms.
Results: DΑPT involves a combination of aspirin and platelet P2Y12 receptor inhibitors (clopidogrel, prasugrel, ticagrelor). Patients adherence to this therapy tends to decrease with time after PCI, mainly from 6 to 12 months. According to literature, 1 in 3 patients discontinue the P2Y12 inhibitor earlier than the prescribed time. Factors influencing adherence are related to the healthcare system of each country, patients (demographic, economic, social) and comorbidities. Adherence with other medications before PCI is associated with DAPT discontinuation after the procedure. In clinical settings, healthcare professionals either do not have enough time or are not fully familiar with adherence measurements. Also, the short length of hospital stay undermines adherence assessment. Educational interventions that begin in the clinical setting and include post-discharge follow-up are effective in adherence improvement.
Conclusions: A stable therapeutic relationship between patients and healthcare professionals is essential for understanding the factors that determine the degree of DAPT adherence. Given that, adherence is a dynamic and changing process over time, improvement efforts are effective when measurements are repeated.