Memahami Terapi Dual Antiplatelet setelah Percutaneous Coronary Intervention

Oleh :

dr. Hendra Gunawan SpPD-KKV

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 trombosis stent, infark miokard, stroke, hingga kematian akibat kejadian kardiovaskular.[1]

Dalam memutuskan terapi dual antiplatelet, pertimbangan klinisi dalam memilih jenis obat secara garis besar meliputi: karakteristik pasien, interaksi obat, maupun ketersediaan pilihan obat. Selain faktor jenis obat, durasi terapi antiplatelet juga harus menjadi pertimbangan bagi klinisi. Hal ini bertujuan untuk menurunkan risiko terjadinya in-stent restenosis (ISR) yang dapat meningkatkan morbiditas dan mortalitas pada pasien PJK pasca tindakan PCI.[1,2]

Manfaat dan Risiko Penggunaan Terapi Dual Antiplatelet

(Konten ini khusus untuk dokter. Registrasi untuk baca selengkapnya)

Referensi

1. Bagur R, Jolly SS. Dual Antiplatelet Therapy After Percutaneous Coronary Intervention. Circulation: Cardiovascular Interventions. 2018;11:e007368
2. Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). European Heart Journal. 2023;44(38):3720-826
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. Valgimigli M, Gragnano F, Branca M, et al; Single Versus Dual Antiplatelet Therapy (Sidney-3) Collaboration. Ticagrelor or Clopidogrel Monotherapy vs Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: A Systematic Review and Patient-Level Meta-Analysis. JAMA Cardiol. 2024 May 1;9(5):437-448. doi: 10.1001/jamacardio.2024.0133
6. Kinlay S, Young MM, Sherrod R, Gagnon DR. Long-Term Outcomes and Duration of Dual Antiplatelet Therapy After Coronary Intervention With Second-Generation Drug-Eluting Stents: The Veterans Affairs Extended DAPT Study. J Am Heart Assoc. 2023 Jan 17;12(2):e027055. doi: 10.1161/JAHA.122.027055
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. Palmerini T, Della Riva D, Benedetto U, et al. Three, six, or twelve months of dual antiplatelet therapy after DES implantation in patients with or without acute coronary syndromes: an individual patient data pairwise and network meta-analysis of six randomized trials and 11 473 patients. Eur Heart J. 2017;38(14):1034-43
9. Rao SV, O’Donoghue ML, Ruel M, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025;151(13):e771-e862
10. Natsuaki M, Watanabe H, Morimoto T, Yamamoto K, Obayashi Y, Nishikawa R, et al. An Aspirin-Free Versus Dual Antiplatelet Strategy for Coronary Stenting: STOPDAPT-3 Randomized Trial. Circulation. 2024;149(8):585-600
11. Kim CJ, Park M-W, Kim MC, et al. Unguided de-escalation from ticagrelor to clopidogrel in stabilised patients with acute myocardial infarction undergoing percutaneous coronary intervention (TALOS-AMI): an investigator-initiated, open-label, multicentre, non-inferiority, randomised trial. The Lancet. 2021;398(10308):1305-16
12. Urban P, Mehran R, Colleran R, Angiolillo DJ, Byrne RA, Capodanno D, et al. Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk. Eur Heart J. 2019;40(31):2632-53
13. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC) - Supplementary Data. European Heart Journal. 2023;44(38):3720-826