Outcomes of ≤6-month versus 12-month dual antiplatelet therapy after drug-eluting stent implantation

Villablanca, Pedro A.; Massera, Daniele; Bangalore, Sripal; Christia, Panagiota; Perez, Irving E.; Wan, Ningxin; Schulz-Schüpke, Stefanie; Briceño, David; Bortnick, Anna E.; García, Mario J.; Lucariello, Richard J.; Menegus, Mark; Pyo, Robert; Wiley, Jose; Ramakrishna, Harish

doi:10.1097/md.0000000000005819

Cited by 10 publications

(6 citation statements)

References 33 publications

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“…7,[9][10][11][12]26,27 Fifteen published meta-analyses compared 3-6 months vs 12 months of DAPT. [28][29][30][31][32][33][34][35][36][37][38][39] A consistent finding was that lower rates of bleeding were associated with shorter courses of DAPT. [28][29][30][31][32][33][34][35]38 Thirteen meta-analyses showed no difference in ischemic or thrombotic end points with shorter courses of DAPT.…”

Section: Duration Of Dapt In Patients Treated With Pci For Acsmentioning

confidence: 94%

“…[28][29][30][31][32][33][34][35][36][37][38][39] A consistent finding was that lower rates of bleeding were associated with shorter courses of DAPT. [28][29][30][31][32][33][34][35]38 Thirteen meta-analyses showed no difference in ischemic or thrombotic end points with shorter courses of DAPT. 29,[31][32][33][34][35][36] Meta-analyses have also evaluated longer vs shorter durations of DAPT in various patient subgroups, in which a consistent finding was that a shorter duration of DAPT might give rise to an increased risk of ischemic outcomes.…”

Section: Duration Of Dapt In Patients Treated With Pci For Acsmentioning

confidence: 94%

“…[28][29][30][31][32][33][34][35]38 Thirteen meta-analyses showed no difference in ischemic or thrombotic end points with shorter courses of DAPT. 29,[31][32][33][34][35][36] Meta-analyses have also evaluated longer vs shorter durations of DAPT in various patient subgroups, in which a consistent finding was that a shorter duration of DAPT might give rise to an increased risk of ischemic outcomes. These groups include previous ACS, 40 multivessel disease, 17 and complex PCI.…”

Section: Duration Of Dapt In Patients Treated With Pci For Acsmentioning

confidence: 99%

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2018 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Focused Update of the Guidelines for the Use of Antiplatelet Therapy

Mehta

Bainey

Cantor

et al. 2018

Canadian Journal of Cardiology

184

248

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Antiplatelet therapy (APT) has become an important tool in the treatment and prevention of atherosclerotic events, particularly those associated with coronary artery disease. A large evidence base has evolved regarding the relationship between APT prescription in various clinical contexts and risk/benefit relationships. The Guidelines Committee of the Canadian Cardiovascular Society and Canadian Association of Interventional Cardiology publishes regular updates of its recommendations, taking into consideration the most recent clinical evidence. The present update to the 2011 and 2013 Canadian Cardiovascular Society APT guidelines incorporates new evidence on how to optimize APT use, particularly in situations in which few to no data were previously available. The recommendations update focuses on the following primary topics: (1) the duration of dual APT (DAPT) in patients who undergo percutaneous coronary intervention (PCI) for acute coronary syndrome and non-acute coronary syndrome indications; (2) management of DAPT in patients who undergo noncardiac surgery; (3) management of DAPT in patients who undergo elective and semiurgent coronary artery bypass graft surgery; (4) when and how to switch between different oral antiplatelet therapies; and (5) management of antiplatelet and anticoagulant therapy in patients who undergo PCI. For PCI patients, we specifically analyze the particular considerations in patients with atrial fibrillation, mechanical or bioprosthetic valves (including transcatheter aortic valve replacement), venous thromboembolic disease, and established left ventricular thrombus or possible left ventricular thrombus with reduced ejection fraction after ST-segment elevation myocardial infarction. In addition to specific recommendations, we provide values and preferences and practical tips to aid the practicing clinician in the day to day use of these important agents.

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Section: Duration Of Dapt In Patients Treated With Pci For Acsmentioning

confidence: 94%

Section: Duration Of Dapt In Patients Treated With Pci For Acsmentioning

confidence: 94%

Section: Duration Of Dapt In Patients Treated With Pci For Acsmentioning

confidence: 99%

See 1 more Smart Citation

2018 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Focused Update of the Guidelines for the Use of Antiplatelet Therapy

Mehta

Bainey

Cantor

et al. 2018

Canadian Journal of Cardiology

184

248

View full text Add to dashboard Cite

show abstract

“…Prior studies have noted the importance of monitoring bleeding, which is a common and frequently devasting complication, in elderly patients 12 . In addition, a strong relationship between all bleeding and noncardiac death has been reported in a meta‐analysis 21 . A possible explanation for this might be that patients who experience bleeding events seem to have more likely undergone an interruption or disruption in dual antiplatelet therapy.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of bivalirudin in elderly patients with coronary artery disease undergoing percutaneous coronary intervention: A real‐world study

Liu

et al. 2022

Cathet Cardio Intervent

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Objective: To assess the effectiveness and safety of bivalirudin compared with heparin monotherapy in elderly patients undergoing percutaneous coronary intervention (PCI).Background: Bivalirudin is recommended for periprocedural use in patients undergoing PCI who are of high bleeding risk. However, its safe and efficacious use in elderly patients, a typical high bleeding risk cohort, in real world practice is yet to be reported. Methods:In this single center, real-world observational study, 4736 consecutive elderly patients who underwent PCI were enrolled. Of these, 1240 were treated with bivalirudin and 3496 with heparin according to the periprocedural anticoagulation strategies of PCI. The primary outcome was 12-month net adverse clinical events (NACE) defined as a composite of cardiac death, myocardial infarction, stroke, revascularization, or any bleeding. Propensity score matching (PSM) was used to balance baseline characteristics between groups.Results: After PSM, bivalirudin was found to be associated with lower rates of NACE (19.1% vs. 24.7%, p = 0.002), cardiac death (2.7% vs. 4.3%, p = 0.038), and any bleeding (10.0% vs. 12.9%, p = 0.023) compared to heparin monotherapy. No differences were found in the incidences of myocardial infarction, stroke, revascularization, stent thrombosis (0.1% vs. 0.1%, p = 1.000), and major bleedings (0.5% vs. 0.5%, p = 1.000) between the two patient groups. Conclusion:In this real-world observational study, periprocedural use of bivalirudin in elderly patients who underwent PCI was associated with less cardiac death and any bleeding compared to heparin monotherapy, without increased risk of stent thrombosis.

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“…Due to the reduced risk of thrombotic complication with recent stents, the more recent recommended length for strong antiplatelet therapy using the combination of aspirin and P2Y 12 inhibitors has been shortened [ 13 – 15 ]. In general, the risk of thrombotic events is no longer higher than the risk of serious bleeding complication caused by dual antiplatelet therapy several months after DES implantation [ 16 ]. Stent thrombosis in late term is rare but is an event that can lead to severe, negative patient outcomes including death [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Computer Simulation of Platelet Adhesion around Stent Struts in the Presence and Absence of Tissue Defects around Them

Kawamura

Tamura

Goto

et al. 2021

Journal of Interventional Cardiology

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Aim. To predict platelet accumulation around stent struts in the presence or absence of tissue defects around them. Methods. Computer simulations were performed using virtual platelets implementing the function of the three membrane proteins: glycoprotein (GP) Ibα, GPIIb/IIIa, and GPVI. These platelets were perfused around the stent struts implanted into the vessel wall in the presence or absence of tissue defects around them using within the simulation platform. The number of platelets that adhered around stent struts was calculated by solving the blood flow using Navier–Stokes equation along with the adhesion of membrane protein modeled within the platform. Results. Platelet accumulation around stent struts occurred mostly at the downstream region of the stent strut array. The majority of platelets adhered at the downstream of the first bend regardless of the tissue defect status. Platelet adhesion around stent struts occurred more rapidly in the presence of tissue defects. Conclusion. Computer simulation using virtual platelets suggested a higher rate of platelet adhesion in the presence of tissue defects around stent struts.

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Outcomes of ≤6-month versus 12-month dual antiplatelet therapy after drug-eluting stent implantation

Abstract: Supplemental Digital Content is available in the text

Cited by 10 publications

References 33 publications

2018 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Focused Update of the Guidelines for the Use of Antiplatelet Therapy

2018 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Focused Update of the Guidelines for the Use of Antiplatelet Therapy

Effectiveness and safety of bivalirudin in elderly patients with coronary artery disease undergoing percutaneous coronary intervention: A real‐world study

Computer Simulation of Platelet Adhesion around Stent Struts in the Presence and Absence of Tissue Defects around Them

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