Should elderly patients stick to clopidogrel? The first large study on prasugrel showed an unacceptable increase of bleeding in elderly patients, suggesting the use of 5 mg (although the sample size was small, which hindered the determination of dose efficacy). Later, ticagrelor showed better efficacy than clopidogrel without apparent safety concerns. However, specific evidence on elderly...
Ticagrelor monotherapy after 3 months of dual antiplatelet therapy in patients who experienced ST-segment elevation infarction significantly reduces major bleeding without increasing ischemic risk. This pre-specified analysis of the TICO study shows that ticagrelor monotherapy is safe even in patients with higher ischemic risk. Interrupting aspirin use after 3 months of dual antiplatelet therapy and continuing treatment...
This meta-analysis to be published in J Am Cardiol supports the use of aspirin monotherapy (ASA) after transcatheter aortic valve replacement (TAVR). The use of aspirin alone is associated to less bleeding without increased ischemic events such as strokes or mortality. The combined outcomes of four studies, including the recently published POPular TAVI (cohort A),...
Switching to ticagrelor monotherapy after 3 months of dual antiplatelet therapy reduces major bleeding without paying a price in terms of ischemic events, compared with dual antiplatelet therapy for a year, in patients who had acute coronary syndrome and underwent angioplasty with a second-generation drug-eluting stent. Interrupting aspirin at 3 months and switching it for ticagrelor reduces...
The original TWILIGHT findings in more than 9000 patients who underwent angioplasty were presented last year at TCT and showed a 3.1% absolute risk reduction in BARC 2, 3, or 5 bleeding with no increase in death, infarction, or stroke in patients who received ticagrelor and placebo compared with patients who received ticagrelor and aspirin. All patients...
The GLOBAL LEADERS study includes a pre-specified sub-study, GLASSY, that showed that ticagrelor monotherapy after one month of dual antiplatelet therapy is non-inferior (but not superior) to conventional treatment in terms of ischemic events. As regards safety, ticagrelor monotherapy did not decrease major bleeding compared with conventional therapy. The GLOBAL LEADERS randomized 15,991 patients who required...
This study was aimed at gaining device registration from the US Food and Drug Administration (FDA) for a polymer-free biolimus A9 drug-coated stent (BioFreedom, Biosensors). The study had two purposes: on the one hand, it meant to reproduce the results of the LEADERS FREE trial (published in 2015) in terms of safety and efficacy with...
Dropping aspirin after the first month and continuing with ticagrelor monotherapy was not better than standard dual antiplatelet therapy (aspirin plus ticagrelor or clopidogrel) in patients who underwent coronary angioplasty. Patrick Serruys presented this work (which was simultaneously published in The Lancet) at the European Society of Cardiology (ESC) Congress 2018 and explained that, given...
Courtesy of Dr. Alejandro Lakowsky, MTSAC (Full Member of the Argentine Society of Cardiology) The New England Journal of Medicine (NEJM) recently published an article about the POINT trial (simultaneously presented at the European Stroke Organisation Conference), a long-awaited randomized clinical trial to assess the efficacy and safety of dual antiplatelet therapy (DAPT) with aspirin...
Most acute coronary syndromes (ACS) are caused by the following three different pathologies: Plaque rupture Plaque erosion Calcified nodule In daily clinical practice, all patients who experience them are treated with angioplasty, regardless of which of these physiopathologies led to the ACS in each case. Some early reports indicate that patients with plaque erosion might...