Non-adherence to medication in patients with acute coronary syndrome (ACS) remains to be solved; the use of polypills and a closer follow up have been tried out (follow up calls and motivation groups). Antiaggregation guidelines recommend dual antiplatelet therapy (DAPT) for at least one year after ACS. Adherence to drug treatment is comprised of multiple…
An Abbreviated Dual Antiplatelet Regimen Is Also Safe in Patients at High Risk for Bleeding Undergoing Complex Angioplasty
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…
High Risk of Bleeding after PCI: More Evidence for Short DAPT
Dual antiaggregation therapy (DAPT) with ASA and P2Y12 during 6 to 12 months is the indicated strategy after DES stenting to reduce ischemic events. However, in patients with elevated risk of bleeding (HBR) guideline and expert recommendations is 1-6 months, since there is plenty of evidence in favor, except for a randomized study, the MASTER…
Two Safe Stents at Two Years in High Bleeding Risk
There is a consistent number of patients presenting high risk of bleeding. In this context, receiving dual antiplatelet therapy (DAPT) for 12 months would not be advisable. Even though the European and American guidelines recommend 1 to 6 months for chronic and acute syndromes in this group, these are often complex PCI cases, which makes…
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…
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…