A Randomized Comparison of TAILOReD Anti-Platelet Therapy According to Platelet Reactivity Versus Uniform Clopidogrel Monotherapy Beyond 12 Months After Drug-eluting Stent Implantation in High-risk Patients: TAILOR-DAPT
Clopidogrel monotherapy has been found effective in reducing ischaemic cardiovascular and haemorrhagic complications in patients with drug-eluting stent (DES) placement. However, concerns remain about the safety of long-term clopidogrel monotherapy in high-risk patients with HPR (high platelet reactivity) who do not respond adequately to clopidogrel. This study aims to evaluate the effectiveness of a patient-tailored antiplatelet therapy strategy that considers platelet aggregation in high-risk patients with DES placement beyond 12 months after stenting.
• Patients \> 18 years old
• Patients who previously underwent percutaneous coronary intervention with drug-eluting stent implantation 12 months (± 3 months) ago.
• At least one high risk characteristics of ischemic events
⁃ High risk patients
• Acute coronary syndrome
• Previous history of cerebrovascular accidents
• Previous history of peripheral artery intervention
• Heart failure
• Diabetes mellitus requiring medication
• Chronic kidney disease (regardless of requirement of renal replacement therapy)
⁃ High risk lesions
• Left main disease
• Multivessel disease, 2- or 3- vessels
• Bifurcation lesions requiring 2 or more stents
• Chronic total occlusion
• In-stent restenosis
• Graft lesions
• Diffuse long lesion requiring stent(s) with total stent length ≥28 mm
• Lesion at small sized vessel requiring stent(s) with stent diameter ≤2.5 mm
• Calcified lesions requiring atherectomy