In recent times, a lot has been said about reducing the duration or intensity of antiplatelet therapy following percutaneous coronary intervention (PCI) regardless initial indications. All evidence in support of these arguments might be failing to show the risk of non-culprit lesion events in patients with acute coronary syndromes (ACS). Potent and prolonged antithrombotic therapies…
Virtual ACC 2020 | TICO: Ticagrelor Monotherapy in Acute Coronary Syndromes
Switching to ticagrelor monotherapy after 3 months of dual antiplatelet therapy reduces major bleeding without paying a price in terms of ischemic events, compared with dual antiplatelet therapy for a year, in patients who had acute coronary syndrome and underwent angioplasty with a second-generation drug-eluting stent. Interrupting aspirin at 3 months and switching it for ticagrelor reduces…
Virtual ACC 2020 | TWILIGHT-COMPLEX: Ticagrelor Monotherapy in the Most “Dangerous” Angioplasties
The original TWILIGHT findings in more than 9000 patients who underwent angioplasty were presented last year at TCT and showed a 3.1% absolute risk reduction in BARC 2, 3, or 5 bleeding with no increase in death, infarction, or stroke in patients who received ticagrelor and placebo compared with patients who received ticagrelor and aspirin. All patients…
Virtual ACC 2020 | TWILIGHT-DM: Ticagrelor Monotherapy in Diabetic Patients
In parallel to the TWILIGHT in patients with complex PCI, Dr. Angiolillo virtually presented the sub-study in diabetic patients, and it was published simultaneously in J Am Coll Cardiol. This study focuses on the clinical complexity of patients, rather than the technical complexity of the procedure itself. The TWILIGHT-DM analyzed 2620 diabetic patients from the…
Virtual ACC 2020 | TAILOR-PCI: Gene-Based Prescribing of Clopidogrel Does Not Change Outcomes
This very interesting work leaves us with a sour taste in our mouth, as it failed to meet its primary endpoint. Using genotype to individualize treatment with a P2Y12 inhibitor in patients with acute coronary syndrome or stable patients after a scheduled angioplasty compared with conventional treatment with clopidogrel does not reduce the risk of…
Alternatives for Patients Allergic to Aspirin
Intolerance to aspirin is relatively frequent and there is no other non-steroid anti-inflammatory medication to replace it. The new guidelines of chronic coronary syndromes make class IIb recommendations to use prasugrel or ticagrelor in aspirin-intolerant patients. This is not meant to replace dual antiaggregation therapy in aspirin intolerant patients, when needed; it is just a…
Ticagrelor Monotherapy One Month After DES Implantation
The GLOBAL LEADERS study includes a pre-specified sub-study, GLASSY, that showed that ticagrelor monotherapy after one month of dual antiplatelet therapy is non-inferior (but not superior) to conventional treatment in terms of ischemic events. As regards safety, ticagrelor monotherapy did not decrease major bleeding compared with conventional therapy. The GLOBAL LEADERS randomized 15,991 patients who required…
We Should Indicate More than 6 Months of DAPT in Lower Limb Disease
Courtesy of Dr. Carlos Fava. Advanced peripheral vascular disease is frequently associated with cardiovascular events and amputation. It has been proven that mono-antiplatelet therapy (MAPT) offers some benefit (with either aspirin or clopidogrel), but there are scarce data on the role of dual antiplatelet therapy (DAPT) in these patients. Researchers analyzed 404 patients who received MAPT for…
AHA 2019 | TWILIGHT: Discontinue Aspirin after Acute Coronary Syndrome
This study findings confirm less bleeding at no extra cost of thrombotic events when aspirin is discontinued after an acute coronary syndrome (ACS). In the same line as the original TWILIGHT, this study focused on ACS patients alone (excluding STEMI) and confirmed that aspirin discontinuation after 3-month DAPT to continue with ticagrelor alone, reduced the…
Major Bleeding in Patients with Aspirin Plus Rivaroxaban
The combination of coronary artery disease or peripheral vascular disease and a reason for anticoagulation, such as atrial fibrillation, results in many patients who receive antiplatelet therapy with aspirin plus anticoagulation with rivaroxaban, for example. It is a well-known fact that this combination (aspirin 100 mg per day plus rivaroxaban 2.5 mg twice per day) reduces cardiovascular…
Major Bleeding in Patients with Aspirin Plus Rivaroxaban
The combination of coronary artery disease or peripheral vascular disease and a reason for anticoagulation, such as atrial fibrillation, results in many patients who receive antiplatelet therapy with aspirin plus anticoagulation with rivaroxaban, for example. It is a well-known fact that this combination (aspirin 100 mg per day plus rivaroxaban 2.5 mg twice per day) reduces cardiovascular…