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…
HOST-EXAM: The Study that Challenges Aspirin as Long-Term Antiplatelet Therapy
The HOST-EXAM study (which was prospective, randomized, and open-label, with the participation of 37 Korean sites) was specifically designed to determine the role of aspirin as the long-term antiplatelet therapy of choice after angioplasty with current drug-eluting stents. To this end, the study compared aspirin head-to-head with clopidogrel. Over the course of four years, 5438 patients (mean…
ESC 2021 | ISAR-REACT 5: Prasugrel Superior to Ticagrelor in ACS across Kidney Function Spectrum
When we have to choose between two potent P2Y12 receptor inhibitors for a patient undergoing ACS with a planned invasive strategy, kidney function should not interfere in this decision. The main findings of this study were that prasugrel has lower risk of all cause death, MI or stroke, and also had a similar risk of…