P2Y12 inhibitor monotherapy after coronary stenting according to type of P2Y12 inhibitor

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318821
Author(s):  
Juwon Kim ◽  
Woo Jin Jang ◽  
Wang Soo Lee ◽  
Ki Hong Choi ◽  
Joo Myung Lee ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Primary Endpoint ◽  
Dual Antiplatelet Therapy ◽  
Randomised Trial ◽  
Drug Eluting Stent ◽  
Monotherapy Group ◽  
P2y12 Inhibitor ◽  
P2y12 Inhibitors ◽  
Coronary Syndrome ◽  
Drug Eluting

ObjectiveTo compare P2Y12 inhibitor monotherapy after 3-month dual antiplatelet therapy (DAPT) with 12-month DAPT according to the type of P2Y12 inhibitor in patients undergoing percutaneous coronary intervention (PCI).MethodsThe Smart Angioplasty Research Team: Comparison Between P2Y12 Antagonist Monotherapy vs Dual Antiplatelet Therapy in Patients Undergoing Implantation of Coronary Drug-Eluting Stents (SMART-CHOICE) randomised trial compared 3-month DAPT followed by P2Y12 inhibitor monotherapy with 12-month DAPT. In this trial, 2993 patients undergoing successful PCI with drug-eluting stent were enrolled in Korea. As a prespecified analysis, P2Y12 inhibitor monotherapy after 3-month DAPT versus 12-month DAPT were compared among patients receiving clopidogrel and those receiving potent P2Y12 inhibitor (ticagrelor or prasugrel), respectively. The primary endpoint was a composite of all-cause death, myocardial infarction or stroke at 12 months after the index procedure.ResultsAmong 2993 patients (mean age 64 years), 58.2% presented with acute coronary syndrome. Clopidogrel was prescribed in 2312 patients (77.2%) and a potent P2Y12 inhibitor in 681 (22.8%). There were no significant differences in the primary endpoint between the P2Y12 inhibitor monotherapy group and the DAPT group among patients receiving clopidogrel (3.0% vs 3.0%; HR: 1.02; 95% CI 0.64 to 1.65; p=0.93) as well as among patients receiving potent P2Y12 inhibitors (2.4% vs 0.7%; HR: 3.37; 95% CI 0.77 to 14.78; p=0.11; interaction p=0.1). Among patients receiving clopidogrel, P2Y12 inhibitor monotherapy compared with DAPT showed consistent treatment effects across various subgroups for the primary endpoint. Among patients receiving potent P2Y12 inhibitors, the rate of bleeding (Bleeding Academic Research Consortium types 2– 5) was significantly lower in the P2Y12 inhibitor monotherapy group than in the DAPT group (1.5% vs 5.0%; HR: 0.33; 95% CI 0.12 to 0.87; p=0.03).ConclusionsCompared with 12-month DAPT, clopidogrel monotherapy after 3-month DAPT showed comparable cardiovascular outcomes in patients undergoing PCI.Trial registration numberNCT02079194.

Abstract 13108: Optimal Duration of Dual Antiplatelet Therapy after Drug-Eluting Stent Implantation for Off-Label vs. On-Label Indications

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Duk-Woo Park ◽  
Jung-Min Ahn ◽  
Cheol Whan Lee ◽  
Sung-Cheol Yun ◽  
Sung-Han Yoon ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Primary Endpoint ◽  
Dual Antiplatelet Therapy ◽  
Dual Therapy ◽  
Drug Eluting Stent ◽  
Off Label Use ◽  
Off Label ◽  
Risk Of Death ◽  
Drug Eluting ◽  
Label Use

Introduction: The risks and benefits of long-term dual antiplatelet therapy (DAPT) beyond 12 months in patients receiving drug-eluting stents (DES) and with high-risk clinical and angiographic features are unclear. Hypothesis: We try to determine whether extended use of DAPT is beneficial among patients with off-label use of DES. Methods: A total of 5,045 patients were included in the DES LATE trial and stratified according to randomized treatments (aspirin-alone or dual-therapy) and whether use was standard or off-label. Off-label was defined as use in renal insufficiency, ejection fraction ≤30%, acute myocardial infarction (MI), multivessel stenting, total stent length ≥36 mm, or ostial, bifurcation, grafts, left main, restenotic, thrombus, or totally occluded lesions. The primary endpoint was a composite of death from cardiac causes, MI, or stroke at 24 months after randomization. Results: Off-label use occurred in 68.6% of all patients. Among patients with off-label use, the risk of primary endpoint at 2 years was similar between aspirin-alone and dual-therapy group (2.6% vs. 3.1%; hazard ratio: 0.89; 95% confidence interval: 0.59 to 1.34, P = 0.59). In addition, no significant differences were observed between 2 treatment groups for individual and combined risks of efficacy and safety endpoints (death, MI, stroke, stent thrombosis, repeat revascularization, or major bleeding). These findings were consistent in patients with on-label use of DES (Figure). Conclusions: Extended use of DAPT beyond 12 months was not significantly more effective than aspirin monotherapy in reducing the risk of death from cardiac causes, MI, or stroke, regardless of off-label or on-label use of DES.

scholarly journals Perioperative dual antiplatelet therapy for patients undergoing spine surgery soon after drug eluting stent placement

2021 ◽  
Vol 12 ◽  
pp. 302
Author(s):  
Sophie M. Peeters ◽  
Daniel Nagasawa ◽  
Bilwaj Gaonkar ◽  
Tianyi Niu ◽  
Alexander Tucker ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Stent Placement ◽  
Spinal Surgery ◽  
English Language ◽  
Dual Antiplatelet Therapy ◽  
Drug Eluting Stent ◽  
P2y12 Inhibitor ◽  
Stent Type ◽  
Percutaneous Cardiac Intervention ◽  
Drug Eluting

Background: Performing emergent spinal surgery within 6 months of percutaneous placement of drug-eluting coronary stent (DES) is complex. The risks of spinal bleeding in a “closed space” must be compared with the risks of stent thrombosis or major cardiac event from dual antiplatelet therapy (DAPT) interruption. Methods: Eighty relevant English language papers published in PubMed were reviewed in detail. Results: Variables considered regarding surgery in patients on DAPT for DES included: (1) surgical indications, (2) percutaneous cardiac intervention (PCI) type (balloon angioplasty vs. stenting), (3) stent type (drug-eluting vs. balloon mechanical stent), and (4) PCI to noncardiac surgery interval. The highest complication rate was observed within 6 weeks of stent placement, this corresponds to the endothelialization phase. Few studies document how to manage patients with critical spinal disease warranting operative intervention within 6 months of their PCI for DES placement. Conclusion: The treatment of patients requiring urgent or emergent spinal surgery within 6 months of undergoing a PCI for DES placement is challenging. As early interruption of DAPT may have catastrophic consequences, we hereby proposed a novel protocol involving stopping clopidogrel 5 days before and aspirin 3 days before spinal surgery, and bridging the interval with a reversible P2Y12 inhibitor until surgery. Moreover, postoperatively, aspirin could be started on postoperative day 1 and clopidogrel on day 2. Nevertheless, this treatment strategy may not be appropriate for all patients, and multidisciplinary approval of perioperative antiplatelet therapy management protocols is essential.

scholarly journals Impact of Dual Antiplatelet Therapy with Proton Pump Inhibitors on the Outcome of Patients with Acute Coronary Syndrome Undergoing Drug-Eluting Stent Implantation

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Francesca Macaione ◽  
Carla Montaina ◽  
Salvatore Evola ◽  
Giuseppina Novo ◽  
Salvatore Novo
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Stent Implantation ◽  
Dual Antiplatelet Therapy ◽  
Drug Eluting Stent ◽  
Coronary Syndrome ◽  
H2 Antagonist ◽  
Drug Eluting

This study aimed to assess if proton pump inhibitors (PPIs) may reduce the effectiveness of clopidogrel, than H2 antagonist (anti-H2) in order to determine rehospitalization for acute coronary syndrome (re-ACS), target vessel revascularization (TVR) and cardiac death. This case-control study included 176 patients with ACS undergoing angioplasty (PCI) with drug-eluting stent implantation. The population was divided into two groups: PPI group (n=121) consisting of patients receiving at discharge dual antiplatelet therapy (DAT) plus PPI and anti-H2 group (n=55), consisting of patients receiving at discharge DAT + H2 receptor antagonist (H2RA). In a followup of 36 months the prevalence of ACS event (P=0.014), TVR (P=0.031) was higher in the PPI group than in the anti-H2 group; instead there was no statistically significant difference between groups for death. The variables independently associated with ACS were the diabetes, omeprazole, and esomeprazole; instead the variables independently associated with TVR were only omeprazole. Our data shows that the use of omeprazole and esomeprazole, with clopidogrel, is associated with increased risk of adverse outcomes after PCI with drug-eluting stent implantation.

Dual Antiplatelet Therapy After Drug-eluting Stent Implantation

2016 ◽  
Vol 11 (1) ◽  
pp. 51
Author(s):  
Giulia Magnani ◽  
◽  
◽  
Marco Valgimigli
Keyword(s):  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
P2y12 Inhibitor ◽  
Percutaneous Coronary ◽  
Drug Eluting ◽  
Meta Analyses ◽  
Current Guidelines

The current guidelines for percutaneous coronary intervention use recommend dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor after drug eluting stent (DES) implantation. The optimal duration of DAPT is however area of debate. Recent clinical trials and meta-analyses suggest that the choice of DAPT duration should be tailored individually, based on the balance between ischemic and bleeding risk carried by the patient.

scholarly journals Adherence to dual antiplatelet therapy after coronary stenting: A study conducted at two Vietnamese hospitals

2021 ◽  
Vol 13 (4) ◽  
pp. 330-335
Author(s):  
Anh Tien Hoang ◽  
Thi Quynh Nhu Tran ◽  
Cao Phuong Duy Le ◽  
Thi Ha Vo
Keyword(s):  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Drug Eluting Stent ◽  
Chi Square ◽  
Factors Associated ◽  
Telephone Interviews ◽  
Coronary Syndrome ◽  
Inadequate Knowledge ◽  
Chi Square Test ◽  
Drug Eluting

Introduction: Adherence to dual antiplatelet therapy (DAPT) is critical after drug-eluting stent(DES) placement. We aimed to assess patient’s knowledge, rates of DAPT adherence, trends in DAPT use over time, and patient‐level factors associated with nonadherence in the patient with acute coronary syndrome (ACS). Methods: ACS patients who received one or more DES between May and September 2018from two hospitals in Vietnam and used DAPT after stent placement were eligible for a direct interview to assess patient’s knowledge on disease and DAPT. Telephone interviews were conducted one, three, and six months following discharge. Nonadherence was defined as premature discontinuation of DAPT. Factors related to nonadherent patients were analyzed using the chi-square test. Results: Of the 200 patients identified, 154 (77%) participated. Of the ten questions related to knowledge, the mean score of correct answers was 8.2 ± 2.3, and 71.7% had good knowledge.Adherence to DAPT was high at one month (94.2%) but declined by three months (44.2%) and then by six months (46.8%). Aspirin adherence was 99.3%-100% throughout. Three factors associated with nonadherence of DAPT following DES placement by six months included: rural location, linactive occupation, and inadequate knowledge on disease and DAPT (p<0.05). Conclusion: DAPT adherence is high at one month but is suboptimal at three and six months.Factors associated with the nonadherence of DAPT will be helpful in the planning of patient education strategies.

Duration of dual antiplatelet therapy and subsequent monotherapy type in patients undergoing drug-eluting stent implantation: a network meta-analysis

2020 ◽  
Author(s):  
Stefano Benenati ◽  
Gabriele Crimi ◽  
Claudia Canale ◽  
Fabio Pescetelli ◽  
Vincenzo De Marzo ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Major Bleeding ◽  
Dual Antiplatelet Therapy ◽  
Meta Analysis ◽  
Drug Eluting Stent ◽  
P2y12 Inhibitor ◽  
Major Bleeding Rate ◽  
Safety Endpoint ◽  
Secondary Efficacy Endpoint ◽  
Drug Eluting

Abstract Aims  To compare the safety and efficacy of very short (≤3 months), short (6 months), standard (12 months), and extended (&gt;12 months) dual antiplatelet therapy (DAPT), and of subsequent monotherapies, after coronary drug-eluting stent (DES) implantation. Methods and results  Twenty-two randomized control trials (n = 110 059 patients/year) were selected and included in a Bayesian network meta-analysis. The primary efficacy endpoint (PEP) was a composite of cardiac death, myocardial infarction (MI), and stent thrombosis (ST), with each of the components of the PEP being a secondary efficacy endpoint. The primary safety endpoint was major bleeding rate. Compared to standard, we found a lower rate of MI [odds ratio (OR) 0.56, 95% confidence interval (CI) 0.44–0.77] in extended, a lower rate of major bleeding (OR 0.61, 95% CI 0.39–0.87) in very short, and a lower rate of any bleeding (OR 0.61, 95% CI 0.38–0.90) in short DAPT. All DAPT durations were comparable regarding the secondary efficacy endpoints. Very short DAPT followed by P2Y12 inhibition was the treatment of choice to reduce both major bleeding and MI. In the ACS subgroup, extended DAPT (as compared to standard) reduced PEP and ST rates (but not MIs). Conclusion  The efficacy of short and very short is comparable with that of standard DAPT after DES implantation, whereas extended DAPT reduces MI rate. Very short DAPT is associated with lower haemorrhagic events and, followed by a P2Y12 inhibitor monotherapy, should be preferred in order to pursue a trade-off between major bleeding and ischaemic events.

scholarly journals Duration of Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Patients With and Without Acute Coronary Syndrome

2016 ◽  
Vol 91 (8) ◽  
pp. 1084-1093 ◽  
Author(s):  
Abhishek Sharma ◽  
Carl J. Lavie ◽  
Samin K. Sharma ◽  
Akash Garg ◽  
Ajay Vallakati ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Stent Implantation ◽  
Dual Antiplatelet Therapy ◽  
Drug Eluting Stent ◽  
Coronary Syndrome ◽  
Drug Eluting

scholarly journals Dual Antiplatelet Therapy After Drug-eluting Stent Implantation

2016 ◽  
Vol 11 (1) ◽  
pp. 51 ◽  
Author(s):  
Giulia Magnani ◽  
◽  
◽  
Marco Valgimigli
Keyword(s):  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
P2y12 Inhibitor ◽  
Percutaneous Coronary ◽  
Drug Eluting ◽  
Meta Analyses ◽  
Current Guidelines

The current guidelines for percutaneous coronary intervention use recommend dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor after drug eluting stent (DES) implantation. The optimal duration of DAPT is however area of debate. Recent clinical trials and meta-analyses suggest that the choice of DAPT duration should be tailored individually, based on the balance between ischemic and bleeding risk carried by the patient.

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