Optimal duration of dual antiplatelet therapy for coronary artery disease

Kikkert, Wouter J.; Damman, Peter

doi:10.1007/s12471-018-1113-5

Cited by 17 publications

(9 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our finding that 9.7% of AMI patients had a history of AF is similar to a previous study [2]. The risk of ischemic stroke is approximately 1% in post-PCI AF patients [46]. In our study, the risk was even higher at approximately 5% at 1 year and 8% at the end of follow-up in both groups, suggesting additive effects of the intracoronary and systemic prothrombotic environment accompanying AF and AMI.…”

Section: Discussionsupporting

confidence: 90%

Drug-eluting versus bare-metal stents for first myocardial infarction in patients with atrial fibrillation: A nationwide population-based cohort study

Chang

Chen

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

Background Acute myocardial infarction (AMI) complicates the clinical management of atrial fibrillation (AF) because coronary stenting may influence subsequent antithrombotic therapy. We investigated the use of a bare-metal stent (BMS) or a drug-eluting stent (DES) and associated outcomes in patients with pre-existing AF and first AMI undergoing percutaneous coronary intervention. Methods and results Patient records in this population-based study were retrospectively collected from the Taiwan National Health Insurance Research Database. Using propensity score matching (PSM), we used 1:2 ratio stratification into a DES group of 436 and a BMS group of 785 patients from 2007 to 2011. The mean follow-up of matched cohorts was 1.7 years. After PSM, DESs were associated with lower rates of cardiovascular death (7.8%, hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.39-0.86 and 10.1%, HR 0.64, 95% CI 0.45-0.90) and primary composite outcome (35.1%, HR 0.76, 95% CI 0.63-0.92 and 48.2%, HR 0.81, 95% CI 0.69-0.96) than BMSs within the first year and at the end of follow-up. Although the greatest benefit from DESs, irrespective of the first-and second-generation DESs, implantation was observed within the first year only, this benefit was not observed in patients with diabetes, chronic kidney disease, or dialysis.

show abstract

Section: Discussionsupporting

confidence: 90%

Drug-eluting versus bare-metal stents for first myocardial infarction in patients with atrial fibrillation: A nationwide population-based cohort study

Chang

Chen

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…All the studies used an appropriate horizon of analysis ( 12 months) that allows time for all the relevant and significant outcomes to be detected. 45 Five articles examined the CYP2C19*2 LOF allele only, 22,23,26,28,29 which might limit the generalizability of the results, as it is known that *3 is also a common allele. 6 The results of the quality assessment reflected that all the studies had a good quality which means that they adhered to most of the QHES items.…”

Section: Discussionmentioning

confidence: 99%

Economic Evaluations of CYP2C19 Genotype-Guided Antiplatelet Therapy Compared to the Universal Use of Antiplatelets in Patients With Acute Coronary Syndrome: A Systematic Review

AlMukdad

Elewa

Al‐Badriyeh

2020

J Cardiovasc Pharmacol Ther

View full text Add to dashboard Cite

Background and Objectives: Clopidogrel is widely used after the percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) and requires activation by cytochrome P450 (CYP), primarily CYP2C19. Patients with CYP2C19 loss-of-function alleles are at increased risk of major adverse cardiovascular events, while more expensive novel antiplatelet agents (ticagrelor and prasugrel) are unaffected by the CYP2C19 mutations. This systematic review aims to answer the question about whether overall evidence supports the genotype-guided selection of antiplatelet therapy as a cost-effective strategy in post-PCI ACS. Methods: A systematic literature search of PubMed, EMBASE, EconLit, and PharmGKB was done to identify all the economic evaluations related to genotype-guided therapy compared to the universal use of antiplatelets in ACS patients. Quality of Health Economic Studies tool was used for quality assessment. Results: The search identified 13 articles, where genotype-guided treatment was compared to universal clopidogrel, ticagrelor, and/or prasugrel. Six studies showed that genotype-guided therapy was cost-effective compared to universal clopidogrel, while 5 studies showed that it was dominant. One study specified that genotype-guided with ticagrelor is cost-effective only in both CYP2C19 intermediate and poor metabolizers. Genotype-guided therapy was dominant when compared to universal prasugrel, ticagrelor, or both in 5, 1, and 3 studies, respectively. Only 2 studies reported that universal ticagrelor was cost-effective compared to genotype-guided treatment. All the included articles had good quality. Conclusion: Based on current economic evaluations in the literature, implementing CYP2C19 genotype-guided therapy is a cost-effective approach in guiding the selection of medication in patients with ACS undergoing PCI.

show abstract

“…This blurred line between switching to a single antiplatelet agent after DAT discontinuation and maintaining DAT is of considerable debate in clinical studies. Many bleeding risk scores were developed to assist in choosing the adequate therapeutic regimen and its duration, some of the scores being externally validated [ 5 , 6 , 7 , 8 ] ( Table S1 ).…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review on Bleeding Risk Scores’ Accuracy after Percutaneous Coronary Interventions in Acute and Elective Settings

Brinza¹,

Burlacu

Tinică

et al. 2021

Healthcare

View full text Add to dashboard Cite

Dual antiplatelet therapy (DAT) is recommended for all patients undergoing percutaneous coronary intervention (PCI), as it significantly reduces the ischemic risk at the cost of increasing the incidence of bleeding events. Several clinical predictive models were developed to better stratify the bleeding risk associated with DAT. This systematic review aims to perform a literature survey of both standard and emerging bleeding risk scores and report their performance on predicting hemorrhagic events, especially in the era of second-generation drug-eluting stents and more potent P2Y12 inhibitors. We searched PubMed, ScienceDirect, and Cochrane databases for full-text studies that developed or validated bleeding risk scores in adult patients undergoing PCI with subsequent DAT. The risk of bias for each study was assessed using the prediction model risk of bias assessment tool (PROBAST). Eighteen studies were included in the present systematic review. Bleeding risk scores showed a modest to good discriminatory power with c-statistic ranging from 0.49 (95% CI, 0.45–0.53) to 0.82 (95% CI, 0.80–0.85). Clinical models that predict in-hospital bleeding events had a relatively good predictive performance, with c-statistic ranging from 0.70 (95% CI, 0.67–0.72) to 0.80 (95% CI, 0.73–0.87), depending on the risk scores and major hemorrhagic event definition used. The knowledge and utilization of the current bleeding risk scores in appropriate clinical contexts could improve the prediction of bleeding events.

show abstract

Optimal duration of dual antiplatelet therapy for coronary artery disease

Cited by 17 publications

References 43 publications

Drug-eluting versus bare-metal stents for first myocardial infarction in patients with atrial fibrillation: A nationwide population-based cohort study

Drug-eluting versus bare-metal stents for first myocardial infarction in patients with atrial fibrillation: A nationwide population-based cohort study

Economic Evaluations of CYP2C19 Genotype-Guided Antiplatelet Therapy Compared to the Universal Use of Antiplatelets in Patients With Acute Coronary Syndrome: A Systematic Review

A Systematic Review on Bleeding Risk Scores’ Accuracy after Percutaneous Coronary Interventions in Acute and Elective Settings

Contact Info

Product

Resources

About