As regards the use of antithrombotic agents, the risk of bleeding will always be an issue, and in the case of aspirin this risk is twice as big: it does have the desired antiaggregation effect, but on top of the increased bleeding risk, it has a damaging effect on stomach lining that increases the risk…
First Results for Ticagrelor in Elective Coronary Angioplasty
This is one of the first studies on the use of ticagrelor in patients with stable coronary arteries who undergo elective angioplasty. Although its number of patients is low and its endpoints are soft, this work at least provides some support to what is already happening in daily clinical practice. Many patients admitted for a…
What Antiplatelet Therapy Should We Use in Patients with Stroke/TIA? Interesting Results for the POINT Trial
Courtesy of Dr. Alejandro Lakowsky, MTSAC (Full Member of the Argentine Society of Cardiology) The New England Journal of Medicine (NEJM) recently published an article about the POINT trial (simultaneously presented at the European Stroke Organisation Conference), a long-awaited randomized clinical trial to assess the efficacy and safety of dual antiplatelet therapy (DAPT) with aspirin…
Elderly Patients with ACS: Clopidogrel or Reduced-Dose Prasugrel?
Elderly patients are at elevated risk of both ischemic and bleeding complications after an acute coronary syndrome (ACS), and display higher platelet reactivity under clopidogrel when compared to younger patients. A 5-mg dose of prasugrel would provide more predictable platelet inhibition than clopidogrel in elderly populations, without the risk of bleeding entailed by the full…
ACC 2018 | SMART-DATE: 6 Month DAPT Results Suboptimal in ACS
This study compared 6 vs 12 or more months of dual antiplatelet therapy (DAPT) in patients undergoing acute coronary syndrome (ACS) receiving contemporary DES, and it did not find differences in combined endpoint. However, looking at primary endpoint components separately, there were more infarctions in patients with a short DAPT scheme that we cannot ignore. Prolonging antiaggregation…
ACC 2018 | TREAT: Ticagrelor + Fibrinolytics’ Effect on Bleeding
Ticagrelor seems as safe as clopidogrel in patients undergoing ST elevation MI treated with fibrinolytics, at least in terms of TIMI major bleeding at 30 days. Longer follow up will help determine whether there are differences in efficacy or safety issues, as stated by the presenter Otavio Berwanger. This study was presented at ACC 2018 scientific sessions…
Dual Antiplatelet Therapy: Less Is More for Elderly Patients
A recent meta-analysis that will be published soon in JACC Intv offers evidence of benefit derived from short-term dual antiplatelet therapy for elderly patients. This is a patient group that has always been excluded from the major trials, while remaining one of the most challenging subgroups in which to balance bleeding and ischemic risks. The…
Transulnar Access: Another Ace Up Our Sleeve Before Transfemoral Access
Transulnar access can be as safe and effective as transradial access, and it is a particularly good alternative for the preservation of radial artery patency or when such vessel presents a difficult anatomy. This new meta-analysis that will be published soon in Catheter Cardiovasc Interv showed a relatively high failure rate for that access, but…
New Study Shows Ticagrelor + Aspirin Reduce Events Rate
Just when we were starting to understand how long dual antiplatelet therapy should be for our patients, JACC publishes this study where ticagrelor combined with aspirin significantly reduces relative and absolute events rate at long term, especially in patients with multivessel disease. The PEGASUS-TIMI 54 assessed the long-term benefits of two different doses of ticagrelor (60 mg or…
What Is the Best Antiplatelet Therapy in Primary Angioplasty at 12 Months?
Both prasugrel and ticagrelor showed superiority in terms of efficacy, reducing the number of major cardiovascular events at the expense of increased bleeding. This is an affordable cost, and the net clinical benefit supports these new antiplatelet therapies. The one-year follow-up of the PRAGUE-18 study focused on a comparison of efficacy and safety between prasugrel…
Clinical and Economic Costs Compete in the De-Escalation of Antiplatelet Therapy
Patients undergoing primary angioplasty for ST-segment elevation acute myocardial infarction have similar clinical outcomes at 1 year regardless of whether they are treated with ticagrelor or prasugrel, according the PRAGUE-18 study. This new substudy adds an interesting detail: patients who switched from prasugrel and ticagrelor to clopidogrel, citing economic reasons for the “de-escalation” of therapy, were…