TY  - BOOK
AU  - Case, Brian C
AU  - Forrestal, Brian J
AU  - Garcia-Garcia, Hector M
AU  - Torguson, Rebecca
AU  - Waksman, Ron
AU  - Weintraub, William S
AU  - Yerasi, Charan
TI  - Optimizing Monotherapy Selection, Aspirin Versus P2Y12 Inhibitors, Following Percutaneous Coronary Intervention. [Review]
SN  - 0002-9149
PY  - 2020///
KW  - *Aspirin/ad [Administration & Dosage]
KW  - *Dual Anti-Platelet Therapy/mt [Methods]
KW  - *Fibrinolytic Agents/ad [Administration & Dosage]
KW  - *Hemorrhage/pc [Prevention & Control]
KW  - *Percutaneous Coronary Intervention
KW  - *Postoperative Complications/pc [Prevention & Control]
KW  - *Purinergic P2Y Receptor Antagonists/ad [Administration & Dosage]
KW  - Algorithms
KW  - Aspirin/ae [Adverse Effects]
KW  - Fibrinolytic Agents/ae [Adverse Effects]
KW  - Hemorrhage/ci [Chemically Induced]
KW  - Humans
KW  - Time Factors
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
KW  - Review
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - 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
UR  - https://dx.doi.org/10.1016/j.amjcard.2020.07.061
UR  - https://dx.doi.org/10.1016/j.amjcard.2020.07.061
ER  -