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…
Post-PCI Ticagrelor Monotherapy in High-Risk Bleeding
In patients at high risk of bleeding undergoing coronary PCI and after completing 3-month DAPT with no events, you may discontinue aspirin and follow up with ticagrelor monotherapy. This will significantly reduce bleeding without increasing ischemic events. With this strategy, the greater the risk of bleeding, the greater the absolute reduction of bleeding. Patients at…
AHA 2021 | RAPID CABG: Safety of Early Surgical Intervention in Acute Coronary Syndrome
Suspending ticagrelor a couple of days before surgery was non-inferior to waiting 5-6 days in terms of bleeding in patients with acute coronary syndrome (ACS) requiring myocardial revascularization surgery. Patients who waited longer had more ischemic events and longer hospitalizations. Current American guidelines recommend waiting at least 5 days before operating on patients with ACS who…
TCT 2021 | STOPDAPT-2 and MASTER-DAPT: The Conversation Continues from ESC to TCT
Research on short-term dual antiplatelet therapy (DAPT) is still controversial. These discussions, however, seem to lead to the consensus that beyond the “category” of bleeding or ischemic risk, what is most important is a decision tailored to the patient being treated. DAPT duration should be individual, instead of standardized by a risk score. In the…
TCT 2021 | STOPDAPT-2 and MASTER-DAPT: The Conversation Continues from ESC to TCT
Research on short-term dual antiplatelet therapy (DAPT) is still controversial. These discussions, however, seem to lead to the consensus that beyond the “category” of bleeding or ischemic risk, what is most important is a decision tailored to the patient being treated. DAPT duration should be individual, instead of standardized by a risk score. In the…
STOPDAPT-2 ACS: One-Month DAPT NOT Enough in acute patients
One-month dual antiplatelet therapy (DAPT) in patients undergoing acute coronary syndrome (ACS) did not reach the safety and efficacy results observed in the general population of the original trial STOPDAPT-2. The STOPDAPT-2 ACS compared one-month DAPT followed by clopidogrel monotherapy for one year vs. one-year DAPT after PCI. Initially, the study enrolled mostly stable patients…
XIENCE SHORT DAPT | Ideal DAPT Period for Patients at High Risk of Bleeding
In patients at high risk of bleeding undergoing coronary stenting with a Xience stent, 1-to-3-month DAPT period resulted non-inferior to a 6-to-12-month period in terms of ischemic events, and this could be associated to a lower rate of major bleeding and lower stent thrombosis incidence. There is no longer an indication for conventional stents in…
Thrombotic and Bleeding Risk after TAVR: Quick Tips to Stay Up to Date
Transcatheter aortic valve replacement (TAVR) is an increasingly frequent option for patients with severe aortic stenosis across the entire risk spectrum. However, TAVR involves bleeding and thrombosis risk and therefore calls for an optimal adjuvant treatment. Any scheme is complex if we take into account most patients undergoing TAVR are generally elderly and have multiple…
Can Ticagrelor Prevent Strokes in High-Risk Patients?
In addition to aspirin, Ticagrelor offers better prognosis in patients that already had a stroke and have a high-risk cardiovascular profile. These benefits should be correctly balanced seeing as they are not free of risk. Antiplatelet therapy makes part of the standard treatment of cardiac or cerebrovascular patients. Ticagrelor has shown superior to clopidogrel in…
ESC 2021 | ENVISAGE-TAVI AF: Surprise with Endoxaban in TAVR and Atrial Fibrillation
The enthusiasm for direct oral anticoagulants after transcatheter aortic valve replacements (TAVR) is waning. At least, when it combines with atrial fibrillation. The ENVISAGE-TAVI AF has shown excessive bleeding with endoxaban vs. the classical vitamin K antagonists. Endoxaban resulted non-inferior to vitamin K antagonists in terms of net clinical adverse events, but major bleeding events…