Secondary prevention with P2Y12 inhibitors vs aspirin monotherapy in CAD patients Antiaggregation therapy plays a central role at long term to prevent new cardiovascular events in atherosclerosis patients. After repeat myocardial infarction (MI) or stroke, prognosis can vary considerably. Even though the current guidelines prefer aspirin as the first choice for secondary prevention over P2Y12…
P2Y12 Inhibitor Monotherapy vs Aspirin: Results of a Network Meta-Analysis
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…
ESC 2022 | SECURE Trial
This study, presented by Dr. Valentin Fuster, focused on the importance of medical treatment compliance, initially showing data from the FOCUS study where the poor compliance observed in patients after an acute myocardial infarction (AMI) event was improved by creating a polypill (aspirin, simvastatin, and ramipril). Based on this, the SECURE randomized study was conducted…
Should Aspirin Be the Standard of Secondary Prevention of MACE?
Much has been published recently on short term dual antiplatelet therapy (DAPT) both in acute (ACS) and chronic coronary syndrome (CCS) as well as safety of P2Y12 inhibitor monotherapy. When discussing secondary prevention in patients with established coronary artery disease, aspirin (ASA) has been the preferred drug for the prevention of new atherothrombotic events. This…
Are Antithrombotics Necessary in Outpatients after COVID-19?
According to this recent study (soon to be published in JAMA), antithrombotic therapy has no clinical benefits for outpatients with stable symptoms of COVID-19. Both aspirin and apixaban in therapeutic or prophylactic doses did not reduce major cardiovascular events compared against placebo, though these events are rare, which makes it difficult to show any benefit. …
HOST-EXAM: The Study that Challenges Aspirin as Long-Term Antiplatelet Therapy
The HOST-EXAM study (which was prospective, randomized, and open-label, with the participation of 37 Korean sites) was specifically designed to determine the role of aspirin as the long-term antiplatelet therapy of choice after angioplasty with current drug-eluting stents. To this end, the study compared aspirin head-to-head with clopidogrel. Over the course of four years, 5438 patients (mean…
The Role of Aspirin after the TWILIGHT-ACS
This analysis corroborates the potential benefit of ticagrelor monotherapy following a short period of dual antiaggregation (DAPT) in patients with acute coronary syndrome (ACS). This benefit consists of a significant bleeding reduction (3.6% vs. 7.6%, P < 0.001), without compromising ischemic events (4.3% vs. 4.4%, P = 0.84). The latter, however, could be seen as…
AAS vs DAPT post TAVI: Meta-Analysis of Randomized Studies
Aspirin monotherapy (ASA) reduced the combined risk of thrombotic and bleeding events compared against dual antiplatelet therapy (DAPT) in patients receiving transcatheter aortic valve replacement (TAVR). This meta-analysis has only reproduced smaller randomize study outcomes and does not include the OCEAN-TAVI registry, the only one that has shown something different so far. Even though ASA…
DAPT vs. Monotherapy: The Dilemma Remains After Surgery
Patients who undergo myocardial revascularization surgery and are discharged on dual antiplatelet therapy (DAPT)—aspirin plus clopidogrel—have a lower risk of major cardiovascular and cerebral events than patients on aspirin monotherapy. Furthermore, the risk of bleeding is not increased for those receiving DAPT. This information comes from a registry of over 18,000 patients recently published in the…
Post TAVR Aspirin vs. Clopidogrel: Conflicting Findings and Guidelines
One month ago we shared a meta-analysis stating aspirin (ASA) as the best antiplatelet following TAVR vs. 3 to 6 dual antiplatelet therapy suggested by guidelines. At that time, guideline recommendations appeared obsolete. Several studies had started to support ASA monotherapy as the best antiaggregation scheme after TAVR. However, in the light of this new…