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…
THEMIS: Ischemic and Hemorrhagic Events in Delicate Balance for Chronic Ticagrelor
The THEMIS study published this week in NEJM, tested chronic ticagrelor + aspirin in diabetic patients with stable coronary artery disease (CAD), but with no prior history of Myocardial infarction (MI) or stroke. The tempting hypothesis behind this study is that reducing ischemic events might increase bleeding events, and this calls for careful cost/benefit assessment. …
TCT 2019 | MODEL U-SES: More Devices for High Risk of Bleeding and Short DAPT
Courtesy of SBHCI. This study tested the safety of dual antiplatelet therapy (DAPT) after only three months of bioresorbable polymer sirolimus DES implantation (Ultimaster). Secondary end point was following with P2Y12 inhibitor monotherapy after the first 3 months compared with aspirin. It included 1695 patients treated with sirolimus eluting Ultimaster receiving 3-month DAPT. After the…
TCT 2019 | EVOLVE Short DAPT: Only 3-month DATP in High Risk Bleeding
Courtesy of the SBHCI. This study used the thin strut everolimus eluting stent with ultrathin abluminal bioresorbable polymer coating chromium platinum stent, basically the Synergy stent. Drug release and polymer degradation within four months facilitate endothelization and would allow a shorter DAPT. Presented during the scientific sessions of TCT 2019, this study included 2009 high…
TCT 2019 | AUGUSTUS ACS: Apixaban vs. Warfarin and Aspirin vs. Placebo in AF and ACS
Courtesy of SBHCI. The safety and efficacy of antithrombotic and antiplatelet treatments in patients with atrial fibrillation admitted with acute coronary syndrome (who receive medical treatment or angioplasty) may vary from that in patients undergoing elective treatment. At 14 days from elective angioplasty or hospitalization due to acute coronary syndrome, patients were randomized in a 2×2…
TCT 2019 | TWILIGHT: Minimal DAPT in High Bleeding Risk Patients
Courtesy of the SBHCI. Monotherapy with a P2Y12 inhibitor after a minimum period (3 months) of dual antiplatelet antiaggregation (DAPT) is a valid treatment option to reduce bleeding in patients at high risk of bleeding complications. The present double-blind study presented at TCT 2019 simultaneously published in NEJM analyzed ticagrelor monotherapy (prior 3 months DAPT)…
ESC 2019 | THEMIS-PCI: Unlike in the Main Study, Here Ticagrelor Is Indeed Effective
This is a sub-study of the THEMIS presented during the ESC 2019 scientific sessions in Paris, and simultaneously published in Lancet. They were all diabetics with stable coronary artery disease, but in this sub-study patients also had prior PCI. It included over 11000 patients with prior PCI for whom the combination of ticagrelor and aspirin…
ESC 2019 | THEMIS: Ticagrelor in Diabetics with Stable Coronary Artery Disease
The use of ticagrelor in patients with stable coronary artery disease significantly reduces the rate of major cardiovascular events when compared against aspirin, according to this study presented on Sunday at ESC 2019 simultaneously published in NEJM, though the cost in terms of major bleeding seems unacceptable. Primary end point rate (composite of cardiovascular death,…
ESC 2019 | POPULAR AGE: Good Old Clopidogrel Still Valid
According to this study, presented during the ESC 2019 scientific sessions, non-ST acute coronary syndrome (NSTE-ACS) patients treated with ticagrelor presented a significantly higher risk of bleeding than patients treated with clopidogrel, with no counterbalance by higher benefit in thrombotic events. Researchers suggest clopidogrel might be the gold standard for this elderly NSTE-ACS population, though…