Shortened dual antiplatelet therapy in contemporary percutaneous coronary intervention era

Attar, Nadeem

doi:10.4330/wjc.v13.i8.243

Cited by 4 publications

(3 citation statements)

References 37 publications

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“…DAPT should be implemented for 12 months following PCI rather than 6 months in patients with a high risk of bleeding, according to a most recent study. The risk of bleeding is increased when DAPT is administered to patients with renal insufficiency who already have platelet dysfunction (33)(34)(35). Several studies have demonstrated that the risk of bleeding does not rise in hemodialysis patients treated with an antiplatelet medication (36), while some studies have shown that the bleeding risk increases (37).…”

Section: Discussionmentioning

confidence: 99%

Comparison of revascularization with conservative medical treatment in maintenance dialysis patient with coronary artery disease: a systemic review and meta-analysis

Zheng

Wang

Zhong

2023

Front. Cardiovasc. Med.

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BackgroundThe primary cause of death among maintenance dialysis patients is coronary artery disease (CAD). However, the best treatment plan has not yet been identified.MethodsThe relevant articles were retrieved from various online databases and references from their inception to October 12, 2022. The studies that compared revascularization [percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)] with medical treatment (MT) among maintenance dialysis patients with CAD were selected. The outcomes evaluated were long-term (with a follow-up of at least 1 year) all-cause mortality, long-term cardiac mortality, and the incidence rate of bleeding events. Bleeding events are defined according to TIMI hemorrhage criteria: (1) major hemorrhage, intracranial hemorrhage or clinically visible hemorrhage (including imaging diagnosis) with decrease of hemoglobin concentration ≥5 g/dl; (2) minor hemorrhage, clinically visible bleeding (including imaging diagnosis) with a drop in hemoglobin of 3–5 g/dl; (3) minimal hemorrhage, clinically visible bleeding with hemoglobin drop <3 g/dl. In addition, revascularization strategy, CAD type, and the number of diseased vessels were considered in subgroup analyses.ResultsA total of eight studies with 1,685 patients were selected for this meta-analysis. The current findings suggested that revascularization was associated with low long-term all-cause mortality and long-term cardiac mortality but a similar incidence rate of bleeding events compared to MT. However, subgroup analyses indicated that PCI is linked to decreased long-term all-cause mortality compared to MT but CABG did not significantly differ from MT in terms of long-term all-cause mortality. Revascularization also showed lower long-term all-cause mortality compared to MT among patients with stable CAD, single-vessel disease, and multivessel disease but did not reduce long-term all-cause mortality among patients with ACS.ConclusionLong-term all-cause mortality and long-term cardiac mortality were reduced by revascularization in comparison to MT alone in patients undergoing dialysis. Larger randomized studies are needed to confirm the conclusion of this meta-analysis.

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Section: Discussionmentioning

confidence: 99%

Comparison of revascularization with conservative medical treatment in maintenance dialysis patient with coronary artery disease: a systemic review and meta-analysis

Zheng

Wang

Zhong

2023

Front. Cardiovasc. Med.

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“…Since the re-endothelialization is delayed, the necessary time of dual antiplatelet therapy (DAPT) is longer [110]. Current international guidelines recommend DAPT after DES implantation in ACS patients for at least 12 months if the bleeding risk is low and for at least 6 months if the bleeding risk is high [111,112].…”

Section: Selection Of Stentmentioning

confidence: 99%

“…Current international guidelines recommend DAPT after DES implantation in ACS patients for at least 12 months if the bleeding risk is low and for at least 6 months if the bleeding risk is high [111,112]. While BMS need only 4-6 weeks of DAPT, they remained indicated in selected high bleeding risk patients requiring time-limited DAPT [110].…”

Section: Selection Of Stentmentioning

confidence: 99%

Current Therapeutic Approach to Acute Myocardial Infarction in Patients with Congenital Hemophilia

Bădescu

Ciocoiu

Rezuş

et al. 2021

Life

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Advances in the treatment of hemophilia have made the life expectancy of hemophiliacs similar to that of the general population. Physicians have begun to face age-related diseases not previously encountered in individuals with hemophilia. Treatment of acute myocardial infarction (AMI) is particularly challenging because the therapeutic strategies influence both the patient’s thrombotic and hemorrhagic risk. As progress has been made in the treatment of AMI over the last decade, we performed an in-depth analysis of the available literature, highlighting the latest advances in the therapy of AMI in hemophiliacs. It is generally accepted that after the optimal substitution therapy has been provided, patients with hemophilia should be treated in the same way as those in the general population. New-generation stents that allow short dual antiplatelet therapy and potent P2Y12 receptor inhibitors have begun to be successfully used. At a time when specific recommendations and relevant data are scarce, our study provides up-to-date information to physicians involved in the treatment of AMI in hemophiliacs.

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Managing Anticoagulation and Dual Antiplatelet Therapy in Patients with Active Bleed or Upcoming Procedure: A Scoping Review

Berkowitz,

Taylor,

Lima

et al. 2023

Journal of Brown Hospital Medicine

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Introduction: The aim of this paper is to provide primary care providers and hospitalists with up-to-date guidance surrounding the management of anticoagulation and antiplatelet agents in periprocedural settings and when unexpected bleeding complications arise. Methods: We searched PubMed, Cochrane CENTRAL, and Web of Science using applicable MeSH terms and keywords. No date limits or filters were applied. Articles cited by recent cardiovascular guidelines were also utilized. Results: For direct oral anticoagulants (DOACs) and vitamin K agonists (VKAs), a patient’s risk for clot and procedural risk of bleeding should be assessed. Generally, patients considered at high risk for venous thromboembolism (VTE) should be bridged, patients at low risk should forgo bridging therapy, and patients in the intermediate range should be evaluated on a case-by-case basis. Emergent anticoagulation reversal treatment is available for both warfarin (i.e., prothrombin complex concentrate, phytonadione) and DOACs (i.e., idarucizumab for dabigatran reversal; andexanet alfa for apixaban and rivaroxaban reversal). DAPT does not need to be held for paracentesis or thoracentesis and is low risk for those needing urgent lumbar punctures. In patients with clinically significant bleeding, those with percutaneous coronary intervention (PCI) performed in the last three months should resume DAPT as soon as the patient is hemodynamically stable, while patients greater than three months out from PCI at high risk of bleed can be de-escalated to single antiplatelet therapy. Conclusions: Appropriate management of anticoagulation and antiplatelet agents in the periprocedural setting and patients with active bleed remains critical in inpatient management.

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Shortened dual antiplatelet therapy in contemporary percutaneous coronary intervention era

Cited by 4 publications

References 37 publications

Comparison of revascularization with conservative medical treatment in maintenance dialysis patient with coronary artery disease: a systemic review and meta-analysis

Comparison of revascularization with conservative medical treatment in maintenance dialysis patient with coronary artery disease: a systemic review and meta-analysis

Current Therapeutic Approach to Acute Myocardial Infarction in Patients with Congenital Hemophilia

Managing Anticoagulation and Dual Antiplatelet Therapy in Patients with Active Bleed or Upcoming Procedure: A Scoping Review

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