Courtesy of Dr. José Álvarez. In patients at high bleeding risk with drug-eluting stents, the duration of dual antiplatelet therapy has been subjected to ongoing review. Guidelines from the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) suggest shortening this treatment to a maximum of three to six months (Class IIb).…
Dual Antiaggregation De-Escalation: A New Paradigm?
De-escalating dual antiaggregation could be the most effective strategy after acute coronary syndrome seeing as it prevents bleeding and cut down costs with no increase of ischemic events. Balancing the effects of dual antiaggregation therapy (DAPT) in the era of potent P2Y12 inhibitors has become the cornerstone of acute coronary syndrome (ACS) management. This meta-analysis…
The Role of Aspirin after the TWILIGHT-ACS
This analysis corroborates the potential benefit of ticagrelor monotherapy following a short period of dual antiaggregation (DAPT) in patients with acute coronary syndrome (ACS). This benefit consists of a significant bleeding reduction (3.6% vs. 7.6%, P < 0.001), without compromising ischemic events (4.3% vs. 4.4%, P = 0.84). The latter, however, could be seen as…
Ticagrelor or Prasugrel for Acute Patients Who Undergo Angioplasty
We are still asking the same question: ticagrelor or prasugrel? With narrow margins between these drugs in terms of efficacy and bleeding, it is difficult to decide which to prescribe. While it has certain methodological limitations, this research published in JAMA seems to clarify the picture at least for patients with acute coronary syndromes who…
AAS vs DAPT post TAVI: Meta-Analysis of Randomized Studies
Aspirin monotherapy (ASA) reduced the combined risk of thrombotic and bleeding events compared against dual antiplatelet therapy (DAPT) in patients receiving transcatheter aortic valve replacement (TAVR). This meta-analysis has only reproduced smaller randomize study outcomes and does not include the OCEAN-TAVI registry, the only one that has shown something different so far. Even though ASA…
DAPT vs. Monotherapy: The Dilemma Remains After Surgery
Patients who undergo myocardial revascularization surgery and are discharged on dual antiplatelet therapy (DAPT)—aspirin plus clopidogrel—have a lower risk of major cardiovascular and cerebral events than patients on aspirin monotherapy. Furthermore, the risk of bleeding is not increased for those receiving DAPT. This information comes from a registry of over 18,000 patients recently published in the…
Post TAVR Aspirin vs. Clopidogrel: Conflicting Findings and Guidelines
One month ago we shared a meta-analysis stating aspirin (ASA) as the best antiplatelet following TAVR vs. 3 to 6 dual antiplatelet therapy suggested by guidelines. At that time, guideline recommendations appeared obsolete. Several studies had started to support ASA monotherapy as the best antiaggregation scheme after TAVR. However, in the light of this new…
EuroPCR 2021 | CELEBRATE-02: Novel Glycoprotein IIb/IIIa Inhibitor for ST-Segment Elevation Infarction
Promising fast subcutaneous administration and a quick and potent antiplatelet effect, here comes a novel glycoprotein IIb/IIa inhibitor called RUC-4. This novel drug was tested in the CELEBRATE-02 study, presented at EuroPCR 2021 and simultaneously published in EuroIntervention. The mean platelet inhibition begins 15 minutes after injection and increases with each of the three tested doses…
Very Short Dual Antiplatelet Therapy after Complex PCI
The 1-month outcomes of dual antiplatelet therapy (DAPT) followed by clopidogrel monotherapy were comparable to 12-month DAPT in patients with both simple and complex PCI. There was no significant interaction between DAPT period and procedure difficulty. This is a post hoc study of the STOPDAPT-2 that looked at the complex PCI patient subgroup. It is…
ACC 2021 | HOST-EXAM: Clopidogrel vs ASA monotherapy post DAPT in PCI patients
Clopidogrel monotherapy after dual antiplatelet therapy (DAPT) was associated with reduced mortality, MI, stroke, and other events in patients receiving PCI compared against aspirin monotherapy (ASA). This information was provided by the Korean HOST-EXAM study, presented at ACC 2021 scientific sessions, and simultaneously published in the Lancet. Researchers followed patients for 2 years and observed…
ACC 2021 | ADAPTABLE: Low Doses of Aspirin Are Equally Effective and Present Lower Bleeding Risk
Patients diagnosed with cardiovascular disease taking aspirin as secondary prevention can take lower doses and achieve the same efficacy level as those taking 325 mg. According to the ADAPTABLE study, presented at the American College of Cardiology (ACC) 2021 Congress and simultaneously published in the New England Journal of Medicine (NEJM), both schemes were associated with…