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…
How To De-Escalate Prasugrel After Acute Coronary Syndrome?
Patients who undergo coronary angioplasty after acute coronary syndrome could de-escalate dual antiplatelet therapy with prasugrel to maintain the protection against ischemic events while lowering their hemorrhagic risk. The HOST-REDUCE-POLYTECH-ACS study (recently published in The Lancet) included 2338 patients who underwent coronary angioplasty in a setting of acute coronary syndrome. Patients were randomized to a year-long…
Ticagrelor to Improve Venous Graft Patency
Saphenous vein graft patency is one of CABG’s “Achilles heals”, especially after the ARTS trial came out showing bilateral internal mammary artery grafting was not superior to simple internal mammary artery grafting. Antiaggregation more potent than aspirin might prolong venous graft patency in cases when the available techniques will fail to improve poor outcomes. Previous…
Evidence or Theory? Antiaggregation Scheme after Peripheral Vascular Intervention
Antiaggregation indication after peripheral intervention (PVI) can vary up to 50% depending on center, operator, and procedure. This highlights the huge variation in indication and the scarce evidence there is on this matter. Most cardiologists would like to simply transfer the information from the coronaries to the superficial femoral, but we can confirm this does…
ESC 2020 | Against the Grain, ASA Monotherapy Appears Superior after TAVR
After TAVR, patients with no anticoagulation indication are favored by monotherapy with aspirin (ASA) vs. dual antiaggregation therapy (DAPT). This study presented at ESC 2020, simultaneously published in NEJM, seems to go against the latest “fashion” (P2Y12 inhibitor monotherapy) and randomized patients to ASA monotherapy vs. DAPT with clopidogrel for 3 months. Unlike with the…
Can Aspirin Use Be Interrupted After Angioplasty?
Aspirin discontinuation 1 to 3 months after angioplasty with continued P2Y12 inhibitor therapy reduces the bleeding risk without an increase in thrombotic events. This is also the case for patients admitted with acute coronary syndrome. Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor has been shown to reduce the risk of major events compared with…
PCI and Anticoagulation: What is the best strategy?
Most patients with atrial fibrillation require anticoagulation to reduce the risk of stroke or systemic embolization. Today, this is achieved with the new direct oral anticoagulants, which present lower intracranial bleeding risk compared against the old vitamin K antagonists. On the other hand, approximately between 5% to 10% of patients receiving PCI also present atrial…
Cardiovascular Risk, Dual Antiplatelet Therapy, and Age. What Should We Know?
Non-adherence to dual antiplatelet therapy varies with age and patients older than 75 years old are those who discontinue treatment most frequently. However, this characteristic in elderly patients was not associated with more cardiovascular events. Treatment compliance protected patients younger than 75 years old from events, while there was increased cardiovascular risk among this population…
ESC 2018 | GLOBAL LEADERS: Ticagrelor Monotherapy Is Not Superior to Classic Therapies After Angioplasty
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…