Coronary microvascular disfunction (CMD) is an important long-term prognosis predictor. CMD treatment can be an effective therapeutic strategy for patients with acute coronary syndrome (ACS). Nevertheless, more studies are needed to assess different strategies. In the PLATO (Study of Platelet Inhibition and Patient Outcomes) study, ticagrelor vs. clopidogrel reduced ischemic events and overall mortality in…
ACC 2022 | ADAPT-TAVR: Endoxaban Is Not Superior to DAPT After TAVR
DAPT-TAVR is a randomized trial that tested endoxaban in patients with no indication for anticoagulation who underwent successful transcatheter aortic valve replacement (TAVR) for symptomatic severe aortic stenosis. This study included 229 patients whose mean age was 80 years; 42% of them were male. Patients were randomized to either endoxaban 60 mg or 30 mg every 24 h or…
ACC 2022 | BENTRACIMAB
This study was presented in phase 2, in a healthy population between 50 and 80 years of age, and it showed the use of Bentracimab reverts the antiplatelet effect of ticagrelor. The study included 205 adults mean age 61, 49% women, previously treated with aspirin and ticagrelor for 48 hrs. who were randomized 3:1 to…
ACC 2022 | PACMAN AMI
Atherosclerosis plaque causing AMI is often large in volume, high in lipids and have a thin fibrous cap. Statins often reduce atherosclerosis progress, but the impact of PCSK 9 inhibitors (alirocumab) after acute coronary syndrome is scarcely known. The aim of this study was to determine the effect of alirocumab using intracoronary imaging (IVUS, OCT,…
REVERSE-IT | Bentracimab: Progress on the Antidote for Ticagrelor in Emergency Scenarios
Optimizing an antiplatelet therapy after an acute coronary syndrome (ACS) aims at reducing the major adverse cardiac events (MACE) caused by atherosclerotic disease. Ticagrelor is a potent P2Y12 inhibitor that directly prevents platelet activation. It is characterized by a rapid and consistent onset of action throughout its administration (twice daily) and its proven pleiotropic effects,…
Ticagrelor Monotherapy after 3 Months: Is the Current Strategy Worth Changing?
Dual antiplatelet therapy (DAPT) after PCI with DES has shown noticeable reduction of thrombotic events, especially in acute coronary syndromes (ACS). However, this therapy encompasses increased bleeding, especially in elderly patients increasingly undergoing percutaneous intervention. Even though most bleeding events might not be fatal (many of them are mostly digestive) they do involve higher hospitalization…
Abbreviated DAPT in ACS: The End of Clopidogrel Monotherapy?
Compared with patients with chronic coronary syndromes, patients with acute coronary syndromes (ACS) are more likely to suffer from long term major adverse cardiac events (MACE). To prevent this, both the American and the European guidelines recommend prolonging dual antiplatelet therapy (DAPT) in this population for at least 12 months. However, in patients with certain clinical…
Acute Coronary Syndrome: What Is Safer, Antiaggregant Monotherapy or De-Escalation?
For several years it has been shown that 12-month dual antiplatelet therapy (DAPT) is mandatory for patients undergoing left main PCI for acute coronary syndrome (ACS). However, though this strategy does reduce thrombotic events and mortality, it also causes undesirable bleeding events followed by hospitalization and antiaggregation interruption for a period of time. A feasible…
Cangrelor: Additional Research Findings Not Translating into Clinical Practice
The potent and fast endovenous platelet inhibition provided by Cangrelor reduces ischemic events early in the course of acute coronary syndrome. However, and despite mounting evidence, the drug is not reaching the clinical practice. This is a sub-analysis of the CHAMPION PHOENIX, which sought the timing, number and type of early events that could be…
Clnical Practice Dissociated from Study Outcomes: Bad News for Our Patients?
Differences in patient characteristics, changes in treatment algorithms, and advances in device technology, together or separately, might limit the applicability of older randomized trials to contemporary clinical practice. In this case, we look at patients and devices used in the contemporary clinical practice vs. those in the EXTEND DAPT. These differences were associated with attenuated…
TICO: Age Impacts the Effect of Antiplatelet Monotherapy
The higher the age, the greater the benefit of ticagrelor monotherapy vs. dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome. This post hoc sub-analysis of the TICO study goes along the same lines as the TWILIGHT study (which we recently discussed), given that age is the most common reason for considering that a…