Short-term dual antiplatelet therapy (DAPT) followed by P2Y12 monotherapy versus traditional DAPT in patients undergoing percutaneous coronary intervention: meta-analysis and viewpoint

AbstractThe optimal duration dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is subject to debate. A short-duration DAPT (one month to three months) followed by P2Y12 monotherapy instead of standard 6 to 12 months DAPT followed by aspirin monotherapy after PCI has been suggested. We meta-analyzed studies comparing short-term ( ≤ 3 months) DAPT followed by P2Y12 monotherapy versus standard DAPT in patients after PCI. In total, 2304 studies were screened at title and abstract level. The primary endpoint was major bleeding. Secondary endpoints included myocardial infarction, stent thrombosis, stroke, and all-cause mortality. Study level data were analyzed. Heterogeneity was assessed using the I2 statistic. Risk rates (RR) were calculated using a random-effects model (DerSimonian and Laird) for clinical outcomes for each individual study and consecutive pooling. In total, 21970 patients from three studies were analyzed. Between P2Y12 inhibitor monotherapy versus DAPT, there were similar rates of major bleeding (RR 0.67 95%CI 0.34 –1.32; p = 0.25; I2 75%), mortality (RR 0.92 95%CI 0.78 –1.09; p = 0.33; I2 0%) and stroke (RR 0.97 95%CI 0.52  − 0.18; p = 0.92; I2 57%). Endpoints assessing thrombotic events showed no statistically significant difference including myocardial infarction (RR 0.99 95%CI 0.85 –1.15; p = 0.86; I2 0%) and stent thrombosis (...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research

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Conclusions: Compared to the non-HBR population, HBR patients experienced worse 4-year outcomes after PCI with CoCr everolimus-eluting stent. Both CTE and MB had a significant impact on subsequent risk of mortality irrespective of bleeding risk. PMID: 31992063 [PubMed - as supplied by publisher]
Source: Circulation - Category: Cardiology Authors: Tags: Circulation Source Type: research
CONCLUSION: In real-world patients at high risk of bleeding, implantation of the polymer-free metallic stent coated with Biolimus-A9 (Biofreedom®; Biosensors Europe, Morges, Switzerland) followed by 1 -month DAPT showed encouraging results without any stent thrombosis. PMID: 31965195 [PubMed - as supplied by publisher]
Source: Herz - Category: Cardiology Tags: Herz Source Type: research
CONCLUSIONS: Monotherapy with clopidogrel, compared to aspirin, after DAPT showed similar clinical outcomes in patients with acute MI treated with DES. PMID: 31845550 [PubMed - as supplied by publisher]
Source: Korean Circulation Journal - Category: Cardiology Tags: Korean Circ J Source Type: research
CONCLUSIONS: Very low- to moderate-certainty evidence suggests no meaningful difference in efficacy outcomes between non-vitamin K antagonist oral anticoagulants (NOAC) and vitamin K antagonists following percutaneous coronary interventions (PCI) in people with non-valvular atrial fibrillation. NOACs probably reduce the risk of recurrent hospitalisation for adverse events compared with vitamin K antagonists. Low- to moderate-certainty evidence suggests that dabigatran may reduce the rates of major and non-major bleeding, and apixaban and rivaroxaban probably reduce the rates of non-major bleeding compared with vitamin K an...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
Abstract BACKGROUND: The clinical efficacy of ticagrelor is questionable in East Asian populations. Patients with acute myocardial infarction (AMI) with multivessel disease (MVD) are considered as high risk patients who might benefit from ticagrelor treatment. The purpose of this study is to compare the clinical effect of ticagrelor and clopidogrel in AMI patients with MVD in Korea. METHODS AND RESULTS: A total of 2275 patients between November 2011 and June 2015, diagnosed with AMI with MVD after successful percutaneous coronary intervention who were registered in the Korea Acute Myocardial Infarction Regist...
Source: Journal of Cardiology - Category: Cardiology Authors: Tags: J Cardiol Source Type: research
Publication date: Available online 5 December 2019Source: Journal of Cardiology CasesAuthor(s): Diego Della Riva, Matteo Bruno, Nevio TaglieriAbstractLarge clinical trials and meta-analyses have shown that thrombus aspiration (TA) in the setting of ST-T segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) does not improve clinical outcome, whilst it may be associated with an increased risk of stroke. Accordingly, in the most recent European Society of Cardiology guidelines the role of routine TA during PPCI has been downgraded to a class III recommendation with level ...
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research
AbstractIntroductionAn increased incidence of stent thrombosis after implantation of first-generation drug-eluting stents led to a recommendation of dual antiplatelet therapy (DAPT) for 12  months after the procedure. However, given the use of second-generation and newer drug-eluting stents, this recommendation needs to be revisited. Several randomized controlled trials (RCTs) have studied an abbreviated DAPT regimen of ≤ 3 months followed by P2Y12 inhibitor monotherapy, and results have been conflicting.ObjectiveWe performed a systematic review with meta-analysis of RCTs of abbreviated DAPT for ...
Source: American Journal of Cardiovascular Drugs - Category: Cardiology Source Type: research
AbstractThere is still a debate about the safety and efficacy of an aspirin free strategy after percutaneous coronary intervention (PCI). Hence, we performed a meta-analysis comparing aspirin free strategy to dual antiplatlets therapy (DAPT). Randomized trials (RCTs) comparing aspirin free strategy to DAPT in patients who received PCI were included. The primary outcome of interest was bleeding, defined per the Bleeding Academic Research Consortium (BARC). Secondary outcomes included major adverse cardiovascular and cerebrovascular events (MACE); defined as all-cause mortality, myocardial infarction or stroke, the individua...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
CONCLUSION: Acute myocardial infarction and hypertrophic cardiomyopathy patients who were obese exhibited worse long-term outcomes than those without obesity. PMID: 31674878 [PubMed - as supplied by publisher]
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
ConclusionLp(a) is an independent predictor of the prevalence of more complex coronary artery lesions (SYNTAX score ≥ 23) in patients with PCI. In addition, our study has shown that Lp(a) has no relationship with long-term cardiovascular outcomes in Chinese patients with PCI.
Source: Nutrition, Metabolism and Cardiovascular Diseases - Category: Nutrition Source Type: research
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