Abbreviated dual antiplatelet therapy in patients at high risk for bleeding and acute myocardial infarction. Patients with acute coronary syndrome (ACS) who undergo stent placement (percutaneous coronary intervention, PCI) conventionally require at least 12 months of dual antiplatelet therapy (DAPT) to reduce ischemic events. Patients with ACS who are also at high risk for bleeding…
Abbreviated Antiaggregant Treatment in High Bleeding Risk Patients from the MASTER-DAPT (15-Month Followup)
Benefits of abbreviated antiaggregant treatment in high bleeding risk patients. Dual antiplatelet therapy (DAPT), established by different guidelines, reduces the risk of ischemic events at the expense of increased bleeding. This habitual APT strategy cannot be applied to patients at high risk of bleeding, which is why this populations are treated with shorter DAPT schemes…
ACC 2023 | COORDINATE-DIABETES
Approximately only 2.7% of all diabetic patients with ischemic heart disease in the United States receive optimal treatment consisting in high doses of statins (ACEI/ARAII) or “cardio-stable” antihyperglycemic agents such as SGLT2I and GLP-1RA (three of them). Of the population, 37.4% does not use any medication. Randomization was conducted at the healthcare facility level, rather…
ACC 2023 | A DUE-Study (Phase III)
In pulmonary hypertension (PHT), 10 mg macitentan plus 40 mg tadalafil is recommended as a safe combination therapy for newly diagnosed patients or in a significant proportion of patients during follow-up. Using a tablet with a fixed drug combination (FDC) could simplify treatment. The aim of this study was to evaluate the efficacy and safety of macitentan/tadalafil…
ACC 2023 | YELLOW III Study. Effect of Evolocumab on Coronary Plaque Characteristics in Stable Coronary Artery Disease
Dr. Kini presented the results of the YELLOW III Study where she analyzed the effect of evolocumab on coronary plaque in patients with stable coronary artery disease. The study included 137 patients who underwent coronary angioplasty to the culprit vessel and endovascular imaging (OCT, NIRS/IVUS) to non-obstructive lesions (30%-50%). If their plaque was lipid-rich (defined…
Rivaroxaban in Acute Coronary Syndrome
Acute coronary syndromes (ACS) involve high mortality risk, especially ST elevation ACS. Their treatment is based on reperfusion, dual antiplatelet therapy (DAPT) and anticoagulation, with enoxaparin (1 mg/kg twice a day) as the preferred anticoagulant according to the contemporary guidelines. 2.5 mg or 5 mg doses of rivaroxaban might be valid alternative treatments for this…
Monotherapy with P2Y12 in Complex Interventions: Less and Less Risky
Monotherapy in patients with complex angioplasty: meta-analysis of 5 randomized studies. Even though prolonged dual antiplatelet therapy (DAPT) might reduce the risk of important ischemic complications, this reduction will come at the expense of a significant increase of bleeding risk, which makes us reassess the cost benefit ratio of this decision. This is also why…
Is Using Drug-Eluting Balloons and Single Antiplatlelet Therapy Safe for Patients at High Risk for Bleeding Who Undergo Percutaneous Coronary Intervention?
The safety and efficacy of drug-coated balloons (DCB) has been established for the treatment of in-stent restenosis of conventional bare-metal stents (BMS) and drug-eluting stents (DES). Furthermore, these devices are also used to treat de novo coronary lesions, as demonstrated in the BASKET-SMALL 2—where DCBs were non-inferior to stents—and the DEBUT RCT trials—, where DCBs…
Is it Possible to Reduce DAPT Time in Diabetic Patients?
Short-duration dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with DES is growing steadily, especially for chronic coronary syndromes. There is also some evidence regarding its use in acute coronary syndrome. However, diabetes is a well-known risk factor for both restenosis and thrombosis, since it involves more complex and longer lesions in vessels that…
Can We Use DAPT for 3 Months in Acute Coronary Syndrome?
Current guidelines recommend 12-month dual antiplatelet therapy (DAPT) after DES stenting for acute coronary syndrome (ACS) because of elevated MACE risk. The development of more modern stents, with thin and ultrathin struts, compared against prior versions, has resulted in more effective devices in terms of stent thrombosis and restenosis. Prolonged DAPT has been associated with…
Is Clopidogrel Monotherapy Safe After a Month of Dual Antiplatelet Therapy in Diabetic Patients?
Currently, many randomized studies have suggested that short-term dual antiplatelet therapy (DAPT) followed by monotherapy reduces bleeding without increasing major cardiovascular events after percutaneous coronary intervention (PCI). A meta-analysis of six randomized studies has shown this benefit using ticagrelor monotherapy after short DAPT. However, there is no data on the results of clopidogrel monotherapy. Researchers…