Optimizing Monotherapy Selection, Aspirin Versus P2Y12 Inhibitors, Following Percutaneous Coronary Intervention. [Review]

MedStar author(s):
Citation: American Journal of Cardiology. 135:154-165, 2020 11 15.PMID: 32962804Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *Aspirin/ad [Administration & Dosage] | *Dual Anti-Platelet Therapy/mt [Methods] | *Fibrinolytic Agents/ad [Administration & Dosage] | *Hemorrhage/pc [Prevention & Control] | *Percutaneous Coronary Intervention | *Postoperative Complications/pc [Prevention & Control] | *Purinergic P2Y Receptor Antagonists/ad [Administration & Dosage] | Algorithms | Aspirin/ae [Adverse Effects] | Fibrinolytic Agents/ae [Adverse Effects] | Hemorrhage/ci [Chemically Induced] | Humans | Time FactorsYear: 2020Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0002-9149
Name of journal: The American journal of cardiologyAbstract: Dual antiplatelet therapy (DAPT) reduces ischemic and thrombotic events after percutaneous coronary intervention (PCI). Initial reports of higher myocardial infarction and mortality rates prompted guideline committees to choose 12-month duration of DAPT after PCI. However, higher bleeding rates with DAPT remain a major concern. Since these guidelines were published, there have been improvements in stent design, deployment techniques, and antiplatelet therapies, which have reduced ischemic events. To address bleeding concerns, trials were performed to evaluate the effectiveness of short-duration DAPT. Two main strategies were employed: (1) aspirin monotherapy after a short-duration DAPT, and (2) P2Y12 inhibitor monotherapy after a short-duration DAPT. In this review, we outline all the major trials on short-duration DAPT that have examined the previously mentioned strategies and propose a new individualized treatment algorithm for which monotherapy to choose or remove after PCI. In conclusion, while removing the P2Y12 inhibitor after a short DAPT appears to be safe in the low-risk population, removing aspirin and continuing the P2Y12 inhibitor as monotherapy would be the preferred strategy in intermediate- to high-risk patients to mitigate the bleeding risk. Copyright (c) 2020 Elsevier Inc. All rights reserved.All authors: Case BC, Forrestal BJ, Garcia-Garcia HM, Torguson R, Waksman R, Weintraub WS, Yerasi COriginally published: American Journal of Cardiology. 2020 Aug 15Fiscal year: FY2021Digital Object Identifier: Date added to catalog: 2020-10-06
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 32962804 Available 32962804

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

Dual antiplatelet therapy (DAPT) reduces ischemic and thrombotic events after percutaneous coronary intervention (PCI). Initial reports of higher myocardial infarction and mortality rates prompted guideline committees to choose 12-month duration of DAPT after PCI. However, higher bleeding rates with DAPT remain a major concern. Since these guidelines were published, there have been improvements in stent design, deployment techniques, and antiplatelet therapies, which have reduced ischemic events. To address bleeding concerns, trials were performed to evaluate the effectiveness of short-duration DAPT. Two main strategies were employed: (1) aspirin monotherapy after a short-duration DAPT, and (2) P2Y12 inhibitor monotherapy after a short-duration DAPT. In this review, we outline all the major trials on short-duration DAPT that have examined the previously mentioned strategies and propose a new individualized treatment algorithm for which monotherapy to choose or remove after PCI. In conclusion, while removing the P2Y12 inhibitor after a short DAPT appears to be safe in the low-risk population, removing aspirin and continuing the P2Y12 inhibitor as monotherapy would be the preferred strategy in intermediate- to high-risk patients to mitigate the bleeding risk. Copyright (c) 2020 Elsevier Inc. All rights reserved.

English

Powered by Koha