P2Y12 Inhibitor or Aspirin Monotherapy for Secondary Prevention of Coronary Events

Journal of the American College of Cardiology, Journal Year: 2023, Volume and Issue: 82(2), P. 89 - 105

Published: July 1, 2023

Language: Английский

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Ticagrelor or Clopidogrel Monotherapy vs Dual Antiplatelet Therapy After Percutaneous Coronary Intervention

JAMA Cardiology, Journal Year: 2024, Volume and Issue: 9(5), P. 437 - 437

Published: March 20, 2024

Importance Among patients undergoing percutaneous coronary intervention (PCI), it remains unclear whether the treatment efficacy of P2Y 12 inhibitor monotherapy after a short course dual antiplatelet therapy (DAPT) depends on type inhibitor. Objective To assess risks and benefits ticagrelor or clopidogrel compared with standard DAPT PCI. Data Sources MEDLINE, Embase, TCTMD, European Society Cardiology website were searched from inception to September 10, 2023, without language restriction. Study Selection Included studies randomized clinical trials comparing adjudicated end points in indication oral anticoagulation Extraction Synthesis Patient-level data provided by each trial synthesized into pooled dataset analyzed using 1-step mixed-effects model. The study is reported following Preferred Reporting Items for Systematic Review Meta-Analyses Individual Participant Data. Main Outcomes Measures primary objective was determine noninferiority vs composite death, myocardial infarction (MI), stroke per-protocol analysis 1.15 margin hazard ratio (HR). Key secondary major bleeding net adverse events (NACE), including point bleeding. Results Analyses included 6 25 960 PCI, whom 24 394 (12 403 receiving DAPT; 8292 monotherapy; 3654 45 prasugrel monotherapy) retained analysis. Trials conducted Asia, Europe, North America; all Asia. Ticagrelor noninferior (HR, 0.89; 95% CI, 0.74-1.06; P = .004), but not 1.37; 1.01-1.87; > .99), this finding driven noncardiovascular death. risk lower both 0.47; 0.36-0.62; < .001) 0.49; 0.30-0.81; .006; interaction 0.88). NACE 0.74; 0.64-0.86, 1.00; 0.78-1.28; .99; .04). Conclusions Relevance This systematic review meta-analysis found that all-cause MI, superior NACE. Clopidogrel similarly associated reduced stroke, largely because observed 1 exclusively East Asian an excess

Language: Английский

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Aspirin-free antiplatelet strategies after percutaneous coronary interventions

European Heart Journal, Journal Year: 2024, Volume and Issue: 45(8), P. 572 - 585

Published: Jan. 18, 2024

Dual antiplatelet therapy (DAPT) with aspirin and a platelet P2Y12 receptor inhibitor is the standard antithrombotic treatment after percutaneous coronary interventions (PCI). Several trials have challenged guideline-recommended DAPT PCI by testing relative clinical effect of an aspirin-free approach-consisting monotherapy short course (mostly 1-3 months) DAPT-among patients undergoing without concomitant indication for oral anticoagulation (OAC). Overall, these studies shown to be associated significant reduction in risk bleeding increase thrombotic or ischaemic events compared continued DAPT. Moreover, effects prior following very are being investigated emerging studies, which one has recently reported unfavourable efficacy results approach conventional Finally, alone been as chronic discontinuation, thus challenging historical role care secondary prevention PCI. A thorough understanding study designs, populations, treatments, results, limitations vs. required consider adopting this practice. This review addresses use strategies among OAC, providing overview evidence, guideline indications, practical implications, ongoing issues, future perspectives.

Language: Английский

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P2Y12 inhibitor monotherapy after short DAPT in acute coronary syndrome: a systematic review and meta-analysis

European Heart Journal - Cardiovascular Pharmacotherapy, Journal Year: 2024, Volume and Issue: 10(7), P. 588 - 598

Published: July 25, 2024

Abstract Background P2Y12 inhibitor monotherapy after a short course of dual antiplatelet therapy (DAPT) may balance ischaemic and bleeding risks in patients with acute coronary syndrome (ACS). However, it remains uncertain how different inhibitors used as affect outcomes. Methods results Randomized controlled trials comparing DAPT (≤3 months) vs. 12-month ACS were included. The primary endpoint was major adverse cardiovascular events (MACE). All analyses included an interaction term for the monotherapy. Trial sequential run to explore whether effect estimate each outcome be affected by further studies. Seven encompassing 27 284 Compared DAPT, associated no difference MACE [odds ratio (OR) 0.92, 95% confidence interval (CI) 0.76–1.12] significant reduction net clinical (NACE) (OR 0.75; CI 0.60–0.94), any 0.54, 0.43–0.66), 0.47, 0.37–0.60). Significant interactions subgroup between ticagrelor clopidogrel found (Pint = 0.016), all-cause death 0.042), NACE 0.018), myocardial infarction 0.028). analysis showed conclusive evidence improved ticagrelor, but not monotherapy, compared standard DAPT. Conclusions In ACS, halves without increasing Ticagrelor, reduced MACE, NACE, mortality supporting its use aspirin discontinuation.

Language: Английский

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Demystifying the Contemporary Role of 12-Month Dual Antiplatelet Therapy After Acute Coronary Syndrome

Circulation, Journal Year: 2024, Volume and Issue: 150(4), P. 317 - 335

Published: July 22, 2024

For almost two decades, 12-month dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS) has been the only class I recommendation on DAPT American and European guidelines, which resulted durations of being most frequently implemented ACS patients undergoing percutaneous intervention (PCI) across globe. Twelve-month was initially grounded results CURE (Clopidogrel Unstable Angina to Prevent Recurrent Events) trial, which, by design, studied versus no rather than optimal duration. The average duration this study 9 months, not 12 months. Subsequent studies, were designed assess duration, its composition (aspirin with prasugrel or ticagrelor compared clopidogrel) further interpreted as supportive evidence for In these median 15 months prasugrel, respectively. Several subsequent studies questioned regimen suggested that should either be fewer at high bleeding risk more ischemic who can safely tolerate treatment. Bleeding, assessment, emerged a treatment modifier maximizing net clinical benefit DAPT, due excessive clear prolonged regimens patients. Multiple de-escalation strategies, including switching from clopidogrel, reducing dose ticagrelor, shortening while maintaining monotherapy have consistently shown reduce without increasing fatal nonfatal cardiovascular cerebral risks DAPT. However, remains class-I despite lack prospectively established evidence, leading unnecessary potentially harmful overtreatment many It is time practice guideline recommendations updated reflect totality regarding ACS.

Language: Английский

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Antithrombotic therapy in patients with acute coronary syndrome: similarities and differences between a European expert consensus document and the 2023 European Society of Cardiology guidelines

European Heart Journal Acute Cardiovascular Care, Journal Year: 2024, Volume and Issue: 13(1), P. 173 - 180

Published: Jan. 1, 2024

Abstract Antithrombotic therapy represents the cornerstone of pharmacological treatment in patients with acute coronary syndrome (ACS). The optimal combination and duration antithrombotic is still matter debate requiring a critical assessment patient comorbidities, clinical presentation, revascularization modality, and/or optimization medical treatment. 2023 European Society Cardiology (ESC) guidelines for management ACS encompassing both without ST segment elevation have been recently published. Shortly before, expert consensus task force produced guidance clinicians on as well chronic syndrome. scope this manuscript to provide appraisal differences similarities between paper latest ESC recommendations oral regimens patients.

Language: Английский

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Antithrombotic Therapy in High Bleeding Risk, Part I

КАРДИОЛОГИЯ УЗБЕКИСТАНА, Journal Year: 2024, Volume and Issue: 17(19), P. 2197 - 2215

Published: Oct. 1, 2024

Language: Английский

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Guiding Intervention for Complex Coronary Lesions by Optical Coherence Tomography or Intravascular Ultrasound

Journal of the American College of Cardiology, Journal Year: 2023, Volume and Issue: 83(3), P. 401 - 413

Published: Oct. 23, 2023

Language: Английский

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Extended Clopidogrel Monotherapy vs DAPT in Patients With Acute Coronary Syndromes at High Ischemic and Bleeding Risk

JAMA Cardiology, Journal Year: 2024, Volume and Issue: 9(6), P. 523 - 523

Published: April 17, 2024

Purinergic receptor P2Y12 (P2Y12) inhibitor monotherapy after a certain period of dual antiplatelet therapy (DAPT) may be an attractive option maintenance treatment for patients undergoing percutaneous coronary intervention (PCI) who are at both high bleeding and ischemic risk (birisk).

Language: Английский

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Safety of cangrelor and transition to oral P2Y12 inhibitors in patients undergoing percutaneous coronary intervention: the ARCANGELO study

European Heart Journal Open, Journal Year: 2023, Volume and Issue: 3(4)

Published: July 1, 2023

Cangrelor is the only intravenous P2Y

Language: Английский

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