We are still asking the same question: ticagrelor or prasugrel? With narrow margins between these drugs in terms of efficacy and bleeding, it is difficult to decide which to prescribe. While it has certain methodological limitations, this research published in JAMA seems to clarify the picture at least for patients with acute coronary syndromes who…
Polypharmacy in Older Adults Elderly: What Medication to Discontinue
Polypharmacy is certainly a problem in the elderly population. Forgetfulness, and drug and dose confusion can lead to multiple problems; in addition, over time, cognitive deterioration will make complicated drug management schemes even more difficult for patients to handle. Aware of this problem, physicians often try to simplify schemes by discontinuing drugs, but what should…
European Consensus on Antithrombotic Management in TAVR
All the controlled randomized evidence recently published called for an updated document on antithrombotic management in transcatheter aortic valve replacement (TAVR). While thrombotic and hemorrhagic complications have diminished over time—as both the technique and the devices have been perfected—, they still remain as common adverse events in TAVR. Recommendations in the 2017 European Guidelines were…
AAS vs DAPT post TAVI: Meta-Analysis of Randomized Studies
Aspirin monotherapy (ASA) reduced the combined risk of thrombotic and bleeding events compared against dual antiplatelet therapy (DAPT) in patients receiving transcatheter aortic valve replacement (TAVR). This meta-analysis has only reproduced smaller randomize study outcomes and does not include the OCEAN-TAVI registry, the only one that has shown something different so far. Even though ASA…
DAPT vs. Monotherapy: The Dilemma Remains After Surgery
Patients who undergo myocardial revascularization surgery and are discharged on dual antiplatelet therapy (DAPT)—aspirin plus clopidogrel—have a lower risk of major cardiovascular and cerebral events than patients on aspirin monotherapy. Furthermore, the risk of bleeding is not increased for those receiving DAPT. This information comes from a registry of over 18,000 patients recently published in the…
Post TAVR Aspirin vs. Clopidogrel: Conflicting Findings and Guidelines
One month ago we shared a meta-analysis stating aspirin (ASA) as the best antiplatelet following TAVR vs. 3 to 6 dual antiplatelet therapy suggested by guidelines. At that time, guideline recommendations appeared obsolete. Several studies had started to support ASA monotherapy as the best antiaggregation scheme after TAVR. However, in the light of this new…
EuroPCR 2021 | CELEBRATE-02: Novel Glycoprotein IIb/IIIa Inhibitor for ST-Segment Elevation Infarction
Promising fast subcutaneous administration and a quick and potent antiplatelet effect, here comes a novel glycoprotein IIb/IIa inhibitor called RUC-4. This novel drug was tested in the CELEBRATE-02 study, presented at EuroPCR 2021 and simultaneously published in EuroIntervention. The mean platelet inhibition begins 15 minutes after injection and increases with each of the three tested doses…
Very Short Dual Antiplatelet Therapy after Complex PCI
The 1-month outcomes of dual antiplatelet therapy (DAPT) followed by clopidogrel monotherapy were comparable to 12-month DAPT in patients with both simple and complex PCI. There was no significant interaction between DAPT period and procedure difficulty. This is a post hoc study of the STOPDAPT-2 that looked at the complex PCI patient subgroup. It is…
ACC 2021 | VOYAGER PAD: Usefulness of Rivaroxaban After Peripheral Angioplasty
Patients with peripheral vascular disease who undergo angioplasty in the lower limbs find benefit from treatment with rivaroxaban, according to the VOYAGER PAD study, presented at the scientific sessions of the American College of Cardiology (ACC) 2021 Congress and simultaneously published in JACC. Patients with said disease present a higher risk of ischemic events not…
ACC 2021 | HOST-EXAM: Clopidogrel vs ASA monotherapy post DAPT in PCI patients
Clopidogrel monotherapy after dual antiplatelet therapy (DAPT) was associated with reduced mortality, MI, stroke, and other events in patients receiving PCI compared against aspirin monotherapy (ASA). This information was provided by the Korean HOST-EXAM study, presented at ACC 2021 scientific sessions, and simultaneously published in the Lancet. Researchers followed patients for 2 years and observed…
ACC 2021 | ATLANTIS: Apixaban After TAVR vs. Standard of Care
Adding apixaban to the treatment of patients undergoing transcatheter aortic valve replacement (TAVR) was non-superior to standard antithrombotic treatment, according to the randomized ATLANTIS trial presented today at the American College of Cardiology (ACC) 2021 Congress. Given its easy indication and good safety profile, it could be an option to vitamin K antagonists for patients with…