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...
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...
Revascularization and antiaggregation guidelines have typically recommended aspirin (AAS) as first choice for secondary prevention of cardiovascular events after DES stenting. However, these past few years this strategy has been called into question, seeing as studies have shown the superiority of P2Y12 inhibitor monotherapy (IP2Y12) with clopidogrel or ticagrelor. There is little data comparing both...
Recent studies on antiplatelet antiaggregation support the use of short dual antiaggregation therapy (DAPT), even in unforeseen scenarios, such as complex PCI. On the contrary, in patients with high ischemic risk, there is still evidence in favor of prolonged antiaggregation, mainly through the DAPT study, which showed lower risk of major ischemic events with DAPT...
Percutaneous left atrial appendage closure (LAAO) with Watchman has FDA approval since March 2015, having shown, in the PROTECT-AF and PREVAIL studies, reduced risk of atrial fibrillation driven stroke, by excluding the left atrial appendage form systemic circulation. Both studies used post procedure standardized protocols involving followup at 45 days and 6 months, imaging, and...
The MASTER DAPT study analyzed the results of an abbreviated (mean 34 days) vs. conventional dual antiplatelet therapy (DAPT) in 4579 patients treated with angioplasty and a biodegradable polymer sirolimus-eluting stent. This recent publication on the same study analyzed the evolution within the same strategies of the subgroup of patients with complex angioplasty and compared...
The incidence of left ventricular thrombosis (LVT) after anterior ST-segment elevation myocardial infarction (STEMI) ranges from 4% to 26%. This is associated with bad long-term evolution. In the past, triple-scheme therapy (vitamin K antagonist plus dual antiplatelet therapy) was recommended to prevent LVT, despite the lack of high-quality scientific evidence and an increase in the...
The WOEST study found a significant reduction in bleeding complications post PCI with oral anticoagulation indication (OAC) when treating patients with dual antiplatelet therapy (DAPT) vs. the triple antithrombotic scheme. Several randomized studies have shown these results. At present, the guidelines recommend using the triple antithrombotic scheme in patients according to ischemic and bleeding risk. ...
Dual antiplatelet therapy (DAPT) after PCI with DES has shown noticeable reduction of thrombotic events, especially in acute coronary syndromes (ACS). However, this therapy encompasses increased bleeding, especially in elderly patients increasingly undergoing percutaneous intervention. Even though most bleeding events might not be fatal (many of them are mostly digestive) they do involve higher hospitalization...
Compared with patients with chronic coronary syndromes, patients with acute coronary syndromes (ACS) are more likely to suffer from long term major adverse cardiac events (MACE). To prevent this, both the American and the European guidelines recommend prolonging dual antiplatelet therapy (DAPT) in this population for at least 12 months. However, in patients with certain clinical...