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Background: Incidence and reasons of dual antiplatelet therapy (DAPT) discontinuation and switching between P2Y12 inhibitors in acute coronary syndrome (ACS) patients treated with a stent have been poorly studied. Methods and Results: In a prospective single-center study, 283 consecutive patients presenting with ACS were treated with stent implantation between July 2015 and January 2016. Follow-up was achieved at 12 months in 273 patients using the electronic patient file and telephone interview. Switching from clopidogrel to a new antiplatelet agent (ticagrelor or prasugrel) or vice versa occurred in 60 (21.2%) patients. The most frequent reasons for switching were medical decisions not associated with bleeding events and concomitant use of chronic oral anticoagulation. Among the patients with a 1-year follow-up, 42 (15.4%) prematurely discontinued DAPT; 25 of them did so due to the need for an invasive procedure. DAPT premature discontinuation was not significantly associated with an increased 1-year risk of cardiovascular death or serious cardiac ischemic events (HR 2.08 [CI 95%: 0.88–4.94, p = 0.099]). Conclusions: DAPT discontinuation and switching between P2Y12 inhibitors are not uncommon in patients with ACS treated with a stent. The most frequent reasons were the need for an invasive procedure and medical decisions.

Peripartum cardiomyopathy is a rare cause of congestive heart failure which develops in the last month of pregnancy or during five months postpartum in women without previously known cardiac disease. Intraventricular thrombi are no unusual and can be identified by echocardiography. We report the case of a woman with peripartum cardiomyopathy whose echocardiographic study showed the presence of biventricular thrombi. This is a quite rare finding with only two cases reported in the literature. Diagnosis, treatment and special situations that could predispose to intracardiac thrombi formation are discussed.

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