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…
ACC 2022 | ADAPT-TAVR: Endoxaban Is Not Superior to DAPT After TAVR
DAPT-TAVR is a randomized trial that tested endoxaban in patients with no indication for anticoagulation who underwent successful transcatheter aortic valve replacement (TAVR) for symptomatic severe aortic stenosis. This study included 229 patients whose mean age was 80 years; 42% of them were male. Patients were randomized to either endoxaban 60 mg or 30 mg every 24 h or…
Ticagrelor Monotherapy after 3 Months: Is the Current Strategy Worth Changing?
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…
Abbreviated DAPT in ACS: The End of Clopidogrel Monotherapy?
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…
Acute Coronary Syndrome: What Is Safer, Antiaggregant Monotherapy or De-Escalation?
For several years it has been shown that 12-month dual antiplatelet therapy (DAPT) is mandatory for patients undergoing left main PCI for acute coronary syndrome (ACS). However, though this strategy does reduce thrombotic events and mortality, it also causes undesirable bleeding events followed by hospitalization and antiaggregation interruption for a period of time. A feasible…
Clnical Practice Dissociated from Study Outcomes: Bad News for Our Patients?
Differences in patient characteristics, changes in treatment algorithms, and advances in device technology, together or separately, might limit the applicability of older randomized trials to contemporary clinical practice. In this case, we look at patients and devices used in the contemporary clinical practice vs. those in the EXTEND DAPT. These differences were associated with attenuated…
TCT 2021 | STOPDAPT-2 and MASTER-DAPT: The Conversation Continues from ESC to TCT
Research on short-term dual antiplatelet therapy (DAPT) is still controversial. These discussions, however, seem to lead to the consensus that beyond the “category” of bleeding or ischemic risk, what is most important is a decision tailored to the patient being treated. DAPT duration should be individual, instead of standardized by a risk score. In the…
TCT 2021 | STOPDAPT-2 and MASTER-DAPT: The Conversation Continues from ESC to TCT
Research on short-term dual antiplatelet therapy (DAPT) is still controversial. These discussions, however, seem to lead to the consensus that beyond the “category” of bleeding or ischemic risk, what is most important is a decision tailored to the patient being treated. DAPT duration should be individual, instead of standardized by a risk score. In the…
STOPDAPT-2 ACS: One-Month DAPT NOT Enough in acute patients
One-month dual antiplatelet therapy (DAPT) in patients undergoing acute coronary syndrome (ACS) did not reach the safety and efficacy results observed in the general population of the original trial STOPDAPT-2. The STOPDAPT-2 ACS compared one-month DAPT followed by clopidogrel monotherapy for one year vs. one-year DAPT after PCI. Initially, the study enrolled mostly stable patients…
XIENCE SHORT DAPT | Ideal DAPT Period for Patients at High Risk of Bleeding
In patients at high risk of bleeding undergoing coronary stenting with a Xience stent, 1-to-3-month DAPT period resulted non-inferior to a 6-to-12-month period in terms of ischemic events, and this could be associated to a lower rate of major bleeding and lower stent thrombosis incidence. There is no longer an indication for conventional stents in…