Atrial fibrillation is the most common arrhythmia and its combination with a history of acute myocardial infarction or coronary angioplasty is quite frequent. According to this study (recently published in JACC), in a real-world population, the combination of direct anticoagulant agents and dual antiplatelet therapy reduces significantly the risk of bleeding and provides similar thromboembolic...
A recent meta-analysis that will be published soon in JACC Intv offers evidence of benefit derived from short-term dual antiplatelet therapy for elderly patients. This is a patient group that has always been excluded from the major trials, while remaining one of the most challenging subgroups in which to balance bleeding and ischemic risks. The...
The DAPT study concluded that continued thienopyridine plus aspirin beyond a year after coronary angioplasty is associated with a decrease in the rate of stent thrombosis and major cardiovascular events. In contrast, there is a significant increase in moderate to severe bleeding when compared with continued aspirin alone. Based on the outcomes of this and...
Courtesy of the SBHCI. This study sought to assess the safety and efficacy of an everolimus-eluting stent with a biodegradable polymer (SYNERGY II) vs. a conventional stent (REBEL) in patients >75 years old with short duration of dual antiplatelet therapy. Before randomization, investigators recorded the planned duration of dual antiplatelet therapy (1 month for stable patients and 6 months...
Courtesy of SBHCI. This new device has, on one hand, an abluminal sirolimus coating, and on the other hand, a luminal CD34 antibody coating for EPC capturing, to potentially accelerate post-PCI reendothelization. Between 2014 and 2016, the study included 1496 patients undergoing acute coronary syndrome (ACS), receiving the new COMBO stent. These patients were randomized...
Several randomized studies have shown that dual antiplatelet therapy (DAPT) is as effective to prevent thrombotic events in the segment treated with PCI, as it is with the rest of the coronary segments. This is very clear. The problem is there are a series of adverse events following P2Y12 inhibitor discontinuation. This phenomenon called rebound effect, happens...
The NIPPON trial (Nobori Dual Antiplatelet Therapy as Appropriate Duration) was a randomized study comparing a short dual antiplatelet therapy scheme (6 months) vs. a prolonged scheme (18 months) in patients receiving the Nobori drug eluting stent (Terumo, Tokyo, Japan) with a biodegradable abluminal polymer. It included 3,773 patients with chronic stable angina or acute coronary...
Newer P2Y12 blockers are the front-line treatment and dual antiplatelet therapy is indicated for 1 year after acute coronary syndrome (ACS). Both prasugrel and ticagrelor offer more ischemic benefit than clopidogrel during the initial phase; however, bleeding complications could increase in the long term. The objective of this study was to assess the safety and efficacy...
Courtesy of Dr. Agustín Vecchia. Currently, the duration of dual antiplatelet therapy (DAPT) after stent placement is one of the most highly debated topics in Cardiology. On the one hand, women are usually underrepresented in trials in our specialty; on the other, the fact that symptoms of coronary disease are different in women is well-known. The aim...
Original Title: 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients with Coronary Artery Disease. Reference: Levine GN et al. Circulation. 2016 Mar 29. [Epub ahead of print]. Courtesy of Dr. Alejandro Lakowsky. The new ACC-AHAGuidelines on the optimal duration of dual antiplatelet therapy(DAPT) in patients with coronary artery disease have just been...