Duration of Dual Anti-Platelet Therapy (DUAL-ACS)

Despite substantial evidence supporting the use of dual anti-platelet therapy in patients with acute coronary syndrome, there remains major uncertainty regarding the optimal duration of therapy. Recent evidence suggests that shorter durations of dual anti-platelet therapy are superior because the avoidance of atherothrombotic events is counterbalanced by the greater risks of excess major bleeding with apparent increases in all-cause mortality with longer durations. We here propose an international randomised controlled trial of 18,318 patients with type 1 myocardial infarction allocated to differing durations of dual anti-platelet therapy. We will use electronic health record linkage to track duration of therapy and clinical outcomes in a real-world, real-time, efficient and highly cost-effective trial. This has the potential to define treatment duration, settle a major outstanding international controversy, and influence modern cardiology practice across the world.

Inclusion Criteria: Aged ≥18 years Clinical diagnosis of Type 1 myocardial infarction In the opinion of the attending clinician requires dual anti-platelet therapy with aspirin and a P2Y12 receptor antagonist Resident in the country of recruitment with their unique health identifier The attending clinician has equipoise regarding the duration of therapy Provision of informed consent Exclusion Criteria: Clear indication for specific duration of dual anti-platelet therapy Type 2 myocardial infarction Contraindication to aspirin or P2Y12 receptor antagonist Non-resident in the country of recruitment Previous recruitment into the trial Inability or unwilling to give informed consent