Courtesy of SBHCI. This study presented at Euro PCR and simultaneously published by JACC Cardiovascular Interventions poses a question that has remained unanswered since the start of TAVR. There is little information on the optimal antithrombotic therapy after transcatheter aortic valve replacement (TAVR). In general, patients receive between 1 and 6 months of dual…
TOPIC: Benefits of Switching Dual Antiplatelet Therapy in Patients with ACS
Newer P2Y12 blockers are the front-line treatment and dual antiplatelet therapy is indicated for 1 year after acute coronary syndrome (ACS). Both prasugrel and ticagrelor offer more ischemic benefit than clopidogrel during the initial phase; however, bleeding complications could increase in the long term. The objective of this study was to assess the safety and efficacy…
Dual antiaggregation time and death by bleeding
Despite the fact that some randomized studies and meta-analyzis have suggested prolonged dual antiaggregation could be associated to increased death rate, the underlying mechanism remains unclear. It is only logical to assume that if there was an actual increase in mortality associated to prolonged antiaggregation, this should be due to bleeding; however, no studies have…
Peripheral artery disease associated to ischemic and bleeding events after DES implantation
Patients with peripheral artery disease (PAD) have higher rates of cardiovascular events after DES implantation, which could be explained partly by higher platelet reactivity. The present work studies the relationship between platelet reactivity and clinical events after PCI in patients with and without a history of peripheral artery disease. The ADAPT-DES study (Assessment of…
Aspirin Desensitization in Patients with Coronary Artery Disease
There are limited data on aspirin desensitization in patients with coronary artery disease (CAD). The aim of this study was to test the safety and efficacy of a rapid desensitization protocol inpatients with a history of aspirin sensitivity about to receive PCI. This was a prospective multicenter observational study, carried out in seven Italian…
Ticagrelor Versus Clopidogrel in Symptomatic Peripheral Vascular Disease
Peripheral vascular disease is considered as a manifestation of systemic atherosclerosis associated with adverse events, both cardiovascular and related to the lower limbs. Previous studies showed that clopidogrel monotherapy is associated with lower risk of events when compared to low doses of aspirin. Such is the rationale behind this article comparing clopidogrel and ticagrelor…
Ticagrelor vs. Prasugel: Similar Safety and Efficacy in Primary Angioplasty
No randomized head-to-head study comparing the efficacy and safety of ticagrelor and prasugrel has been carried out in the last 7 years since these newer P2Y12 inhibitors first showed a higher efficacy relative to clopidogrel. This study was designed to compare the efficacy and safety of prasugrel and ticagrelor in patients with acute myocardial infarction…
Is It Safe to Discontinue Ticagrelor One Day Before CABG?
Courtesy of Dr. Agustín Vecchia. Nearly 10% of patients with acute coronary syndrome (ACS) require surgery. Managing periprocedural dual antiplatelet therapy (DAPT) in ACS patients is controversial and, to date, there are no randomized trials in this regard. Guidelines recommend ticagrelor discontinuation five days prior surgery and in the most emblematic work on this drug…
Prasugrel vs. Ticagrelor in Diabetics with Heart Disease
Diabetic patients are increased risk of thrombotic events, which is why an effective antiplatelet therapy is crucial for these patients. Both prasugrel and ticagrelor have shown to reduce thrombotic complications further than clopidogrel. Subgroup analyzes of the most important studies testing prasugrel and ticagrelor vs. clopidogrel have shown that diabetic patients receiving the new…
Procedural Complexity Affects Decision-Making Regarding DAPT Duration
Much of the speculation around the way of individualizing dual antiplatelet therapy (DAPT) duration after coronary angioplasty has focused on clinical parameters (e. g., diabetes), but a new study published by the Journal of the American College of Cardiology (JACC) and presented at the last European Society of Cardiology (ESC) Congress warns about anatomical factors as…
Dual Antiplatelet Therapy in Men and Women: Are There Differences?
Courtesy of Dr. Agustín Vecchia. Currently, the duration of dual antiplatelet therapy (DAPT) after stent placement is one of the most highly debated topics in Cardiology. On the one hand, women are usually underrepresented in trials in our specialty; on the other, the fact that symptoms of coronary disease are different in women is well-known. The aim…