Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is the treatment of choice for patients with acute coronary syndrome who undergo coronary angioplasty. Different oral P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) present different characteristics as regards efficacy, risk for bleeding, cost, and timing of administration. In this sense, physicians frequently switch among drugs according to...
RE-DUAL PCI outcomes have been published by the New England Journal of Medicine along with their presentation at ESC 2017. The traditional triple anti-thrombotic scheme with dual antiplatelet therapy and warfarin for patients with atrial fibrillation undergoing coronary angioplasty seems to have been left behind. This new study showed that the combination of dabigatran with a P2Y12...
Courtesy of Dr. Agustín Vecchia. As TAVR is expanded to lower risk patients, complications become more relevant. As regards stroke, the PARTNER 2 and SURTAVI one year outcomes are 8.0% and 8.2% respectively. The mechanisms behind this complication have not yet been clarified and, therefore, neither have guideline recommendations in this regard (as we can tell...
Despite the fact that some randomized studies and meta-analyzis have suggested prolonged dual antiaggregation could be associated to increased death rate, the underlying mechanism remains unclear. It is only logical to assume that if there was an actual increase in mortality associated to prolonged antiaggregation, this should be due to bleeding; however, no studies have...
Original Title: Clopidogrel versus Aspirin as an Antiplatelet Monotherapy after 12-Month Dual-Antiplatelet Therapy in the Era of Drug-Eluting Stents. Reference: Taek Kyu Park et al. Circ Cardiovasc Interv. 2016 Jan;9(1):e002816. Courtesy of Dr. José Amadeo Guillermo Álvarez. The use of dual antiplatelet therapy (DAPT) over 12 months after hospitalization for acute myocardial infarction (AMI) or drug...
Original Title: Individualizing Treatment Duration of Dual Antiplatelet Therapy after Percutaneous Coronary Intervention: An Analysis from the DAPT Study. Presenter: Yeh RW. Optimal dual antiplatelet therapy duration for patients receiving stents has started to become clearer, but a new scoring method (DAPT Score) may help single out patients who could either benefit or suffer from extended...
The current recommendation for dual anti-aggregation post-DES implantation is 12 months. However, the ideal length for specific types of stents is unclear. This study aimed to evaluate the clinical non-inferiority at 3 months versus 12 months of dual anti-platelet therapy in patients undergoing coronary angioplasty with zotarolimus-eluting stents. The study randomized 1:1 to 3 months...
This multicenter noninferiority design work included 1399 patients randomized to receive 6 months (n = 682) versus 1 year (n = 717) dual anti-aggregation after implantation of 2nd generation drug-eluting stent. The primary end point was a composite of cardiac death, myocardial infarction, stroke, definite or probable thrombosis, and major bleeding. At 12 months follow-up...
The PARIS registry was a prospective observational study in 5018 patients undergoing coronary angioplasty with stent implantation in 15 centers. Three categories were prespecified in the discontinuation of dual antiplatelet therapy: 1) discontinuation for medical guidance, 2) transient discontinuation for less than 15 days for surgery and 3) permanent abandonment of it by non-adherence or...
Original title: Twelve or 30 Months of Dual Antiplatelet Therapy after Drug-Eluting Stents. Reference: Laura Mauri et al. N Engl J Med 2014;371:2155-66. Dual antiplatelet therapy is recommended after a drug-eluting stent to prevent thrombotic complications. The clinical benefit of this scheme it is not clear beyond one year. Patients were registered to receive a...