The Role of Novel Oral Anticoagulants and Antiplatelet Therapy after Percutaneous Coronary Intervention: Individualizing Therapy to Optimize Outcomes

Shlofmitz, Evan; Shlofmitz, Richard; Lee, Michael S.

doi:10.4070/kcj.2019.0185

Cited by 4 publications

(3 citation statements)

References 58 publications

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“…This suggests that patient-specific factors may play a more substantial role in predicting DAPT noncompliance than angiographic features alone. [27] The findings of this study underscore the importance of addressing sex disparities and various patient-related factors in improving DAPT adherence. Healthcare providers must recognize the unique challenges faced by female patients and individuals with specific comorbidities, low socioeconomic status, and prior CAD history.…”

Section: Discussionmentioning

confidence: 81%

Sex disparity of DAPT noncompliance in patients with left main stem PCI with DES

Iftikhar,

Rana,

Naeem

et al. 2024

Medicine

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This retrospective study aims to explore the sex disparity in dual antiplatelet therapy (DAPT) noncompliance among left main stem percutaneous coronary intervention (PCI) patients with drug-eluting stent (DES) and identify predictors associated with non-adherence. Data were collected from the medical records of 1585 patients, including 1104 males and 481 females, who underwent left main stem PCI with DES. Baseline characteristics, angiographic features, and DAPT compliance rates at 1 month and 12 months were analyzed. Univariate logistic regression was used to identify predictors of DAPT noncompliance. The overall DAPT noncompliance rate at 1 month was 8.5%, increasing to 15.5% at 12 months. Females exhibited slightly higher noncompliance rates than males at both 1 month (15.6% vs 14.5%) and 12 months (28.1% vs 19.0%), although the difference was not statistically significant. Smoking status showed a modest impact on non-adherence, with current smokers exhibiting a lower noncompliance rate (14.9% at 1 month). Prior coronary artery disease history was associated with increased noncompliance at 12 months (18.9%). Angiographic characteristics, including lesion location and Syntax score, had no consistent association with DAPT noncompliance. This study highlights sex disparity in DAPT noncompliance among patients undergoing left main stem PCI with DES. Comorbidities, socioeconomic status, smoking status, and prior coronary artery disease history were identified as predictors of non-adherence.

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Section: Discussionmentioning

confidence: 81%

Sex disparity of DAPT noncompliance in patients with left main stem PCI with DES

Iftikhar,

Rana,

Naeem

et al. 2024

Medicine

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“…Accordingly, practitioners have witnessed major developments in oral antiplatelet therapy for patients undergoing percutaneous coronary intervention, including molecule type (ranging from aspirin to cilostazol, clopidogrel, dipyridamole, prasugrel, ticagrelor and ticlopidine), front-loading strategy, maintenance dose, regimen duration, escalation, de-escalation, and combination (11). On top of this, oral anticoagulants (ranging from warfarin to apixaban, dabigatran, edoxaban and rivaroxaban) can be added to a single oral antiplatelet regimen or even to a dual antiplatelet regimen, in a framework of triple antithrombotic therapy (12). While this scenario might seem complicated at first glance, we should be reminded by ornithological principles that birds do not fly simply because they have wings, but because they go around flapping them.…”

Section: Introductionmentioning

confidence: 99%

Oral antiplatelet therapy in the elderly undergoing percutaneous coronary intervention: an umbrella review

Biondi‐Zoccai¹,

Antonazzo²,

Giordano³

et al. 2020

J Thorac Dis

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Percutaneous coronary intervention has become a mainstay in the management of coronary artery disease. While initially advanced age was considered a relative contraindication to invasive management of coronary artery disease, current cardiovascular practice stands solidly on an early invasive approach for elderly patients, typically based on radial access and drug-eluting stent implantation. Since the advent of coronary stents, oral antiplatelet therapy has proved crucial to maximize the benefits and minimize the risks of stenting, and this holds even truer in older patients rather than in younger ones.Indeed, the elderly is typically at higher risk of thrombotic events as well as bleeding complications, and thus careful decision making must be exercised to prescribe the most appropriate antiplatelet regimen. We thus conducted an umbrella review with scoping purposes on oral antiplatelet therapy in elderly patients undergoing percutaneous coronary intervention, retrieving 8 pertinent systematic reviews. We found that, while several drugs are available, ranging from aspirin to cilostazol, clopidogrel, dipyridamole, prasugrel, ticagrelor, and ticlopidine, most commonly a dual antiplatelet therapy comprising aspirin and a P2Y12 inhibitor is recommended, with subtle adjustments for pretreatment, loading, dose, duration, escalation or de-escalation, with the potential adjunct in selected patients of novel oral anticoagulants. Indeed, a flexible and individualized approach to oral antiplatelet therapy in elderly patients undergoing percutaneous coronary intervention is paramount, factoring patient features (exploiting thrombotic, bleeding and frailty scores), triage (including when appropriate non-invasive assessment of anatomic and functional significance of coronary artery disease), angiographic and other invasive imaging features, interventional technique, stent choice, rehabilitation, and secondary prevention.

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“…Fig.5Stepwise approach to initiate NOAC while on DAPT[50]. *Stent under-expansion, significant edge dissection or residual reference segment disease.…”

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confidence: 99%

Expert Recommendations on the Usage of Non-vitamin K Antagonist Oral Anticoagulants (NOACs) from India: Current Perspective and Future Direction

Pai

Kumar²,

George

et al. 2022

Cardiol Ther

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Non-vitamin K antagonist oral anticoagulants (NOACs) are a new class of anticoagulant drugs used in the prevention and treatment of venous thromboembolism (VTE) and atrial fibrillation (AF). Anticoagulation requires the integration of the correct type and dose of oral anticoagulants based on patient characteristic, and therefore therapy needs to be individualized for each patient. Growing scientific evidence from studies on NOACs has led to a better understanding of their benefits and safety. A large amount of available data creates a necessity for an adaptable practical document for the usage of NOACs in India. The current consensus, developed by experts from India, aims to give recommendations on various frequently raised clinical questions with regards to NOACs and its usage. This practical document provides a platform upon which future guidelines, policies, training, and education for the use of NOACs can be tailored.

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The Role of Novel Oral Anticoagulants and Antiplatelet Therapy after Percutaneous Coronary Intervention: Individualizing Therapy to Optimize Outcomes

Cited by 4 publications

References 58 publications

Sex disparity of DAPT noncompliance in patients with left main stem PCI with DES

Sex disparity of DAPT noncompliance in patients with left main stem PCI with DES

Oral antiplatelet therapy in the elderly undergoing percutaneous coronary intervention: an umbrella review

Expert Recommendations on the Usage of Non-vitamin K Antagonist Oral Anticoagulants (NOACs) from India: Current Perspective and Future Direction

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