Short dual antiplatelet therapy (DAPT) has shown benefits in patients receiving drug eluting stents (DES), reducing bleeding with no concomitant increase in major adverse cardiovascular events (MACE). Traditionally, the therapeutic window was limited to monotherapy with P2Y12 inhibitors during the first year and there are few data on short DAPT followed by long term monotherapy…
Transcatheter Mitral Valve Replacement: DOAC or VKA?
Severe mitral disease is common and currently constitutes a frequent cause of hospitalization and death. While surgery is the treatment of choice, transcatheter mitral valve replacement (TMVR) emerges as a valid alternative in cases of bioprosthesis failure, ring malfunction, or severe mitral annular calcification (MAC). Furthermore, the latest medical guidelines support the recommendation of TMVR…
Use of Apixaban and Post TAVR Valve Thrombosis
TAVR can be associated to early valve thrombosis, characterized by thrombi formation near or attached to the prosthetic valve, with or without valve dysfunction. This dysfunction is associated with increased leaf thickening and reduced leaflet motion, as well as reduced orifice area or increased transvalvular gradient. Triggered multislice CT allows dynamic valve assessment and thrombosis…
Cilostazol in Diabetic Patients with Endovascular Peripheral Revascularization: One Step Beyond Symptom Improvement
In patients with peripheral vascular disease (PVD), the presence of diabetes has been significantly associated with increased failure of critical lower limb ischemia (CLI) treatment, and higher incidence of amputation. This relationship has been attributed mainly to comorbidities and patient characteristics, concomitant peripheral neuropathy and marked microvascular alteration. Also, a high proportion of these patients…
Optimal Duration of DAPT with Oral Anticoagulation After PCI?: 1 Month vs. 3 Months
While the benefits of dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor are recognized, its primary complication is the occurrence of bleeding events, which negatively impact patient morbidity and mortality. Additionally, about 10% of patients undergoing percutaneous coronary intervention (PCI) are on oral anticoagulant therapy, which significantly increases the risk of bleeding when…
AHA 2023 | SELECT Trial: Semaglutide in Patients Without Diabetes
Given the obesity pandemic projected for the year 2035, it is imperative to address this disease as a priority, through well-known hygienic-dietary measures and the use of drugs that have shown promising results. Obesity has been identified as an independent cardiovascular risk factor, even after modifying risk factors associated with diabetes. Semaglutide, a GLP-1 agonist,…
AHA 2023 | Use of Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation
Subclinical atrial fibrillation (AF), generally asymptomatic and of short duration, often requires continuous long-term monitoring using pacemakers or defibrillators for its detection. While subclinical AF is linked to an increased risk of stroke, the usefulness of oral anticoagulation as a treatment remains uncertain. In a double-blind randomized trial, one group received apixaban and the other…
Acute Pulmonary Thromboembolism: When Anticoagulation Alone May Not Be Enough
In recent times, pulmonary thromboembolism (PTE) has been the subject of growing research due to its persistent impact on morbidity and mortality. Acute PTE, if not properly treated or inadequately treated, can lead to a debilitating condition known as post-PTE syndrome, which has been documented in nearly 50% of survivors. The primary treatment strategy for…
TCT 2023 | COMPARE 60/80 HBR TRIAL
This was a randomized study including patients at high risk of bleeding treated with short dual antiplatelet therapy (DAPT). A total 747 patients were recruited, 368 received PCI with the ultrathin Superflex stent with 60 µm struts (SUF), and 364 received the Terumo Tansei with 89 µm struts (SF). Primary end point was NACE at…
TCT 2023 | T-PASS TRIAL, ASA and Ticagrelor in Acute Coronary Syndrome
This is a multicenter randomized study including 2,850 patients with acute coronary syndrome. Patients were randomized to: dual antiplatelet therapy (DAPT) with ASA and ticagrelor during one month (1,426 patients), followed by ticagrelor monotherapy for 12 months, while the other group received DAPT with ASA and ticagrelor during 12 months (1,424 patients). This study was…
Anti-Lipid Therapy in PCI Patients: Monotherapy with Statins or Combination?
According to several studies, in patients with high-risk atherosclerotic disease, such as those affected by coronary artery disease, achieving target LDL levels through high-intensity statin therapy has been shown to lead to a significant reduction in long-term cardiovascular events. Therefore, the management of dyslipidemia has become a fundamental pillar of secondary prevention. However, reaching such…