It is hard to get a handle on the double-edged sword “dual antiplatelet therapy” (DAPT). With new antiplatet agents, the efficacy of DAPT obviously increases; however, as a result there is a price we have to pay. If large surgical procedures cannot be postponed, one might regularly face the situation that major surgery has to be performed despite an increased bleeding tendency. Schotola and coworkers demonstrate in cardiac surgery that there might be a difference in DAPT in terms of perioperative bleeding and transfusion depending on the combination of drugs used (ticagrelor + ASA vs. clopidogrel + ASA). However, this is only one side of the coin: the efficacy of DAPT is probably not only higher in terms of bleeding but also in terms of preventing ischaemic events. Therefore, the results presented only highlight one side, whereas other possible effects might be neglected. As a consequence, the results presented seem evident, but this point of view does not enable one estimate the real risks of one approach or the other.
– Jens Meier
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