Antiplatelet Therapy for Long-term Secondary Prevention After Myocardial Infarction

Bonaca, Marc P.; Sabatine, Marc S.

doi:10.1001/jamacardio.2016.2110

Cited by 11 publications

(9 citation statements)

References 6 publications

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“…The duration of this therapy in patients with drug-eluting stents-whether it should be less than or equal to 6, 12, or .12 months-has been studied in several randomized, controlled trials (RCTs) (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Despite this evidence, optimal duration of DAPT remains controversial and depends on the setting of stent insertion and patient characteristics, as highlighted by several recent meta-analyses (15)(16)(17)(18)(19)(20). On the basis of this information, recent practice guidelines from the American College of Cardiology/American Heart Association and the European Society of Cardiology recommend at least 6 months of DAPT in patients with stable coronary disease who receive a drugeluting stent and suggest DAPT beyond 6 months for patients who are not at high bleeding risk (21,22).…”

Section: Introductionmentioning

confidence: 99%

Duration of Dual Antiplatelet Therapy in Patients with CKD and Drug-Eluting Stents

Mavrakanas

Chatzizisis

Gariani³

et al. 2019

CJASN

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Background and objectives Whether prolonged dual antiplatelet therapy (DAPT) is more protective in patients with CKD and drug-eluting stents compared with shorter DAPT is uncertain. The purpose of this meta-analysis was to examine whether shorter DAPT in patients with drug-eluting stents and CKD is associated with lower mortality or major adverse cardiovascular event rates compared with longer DAPT.Design, setting, participants, & measurements A Medline literature research was conducted to identify randomized trials in patients with drug-eluting stents comparing different DAPT duration strategies. Inclusion of patients with CKD was also required. The primary outcome was a composite of all-cause mortality, myocardial infarction, stroke, or stent thrombosis (definite or probable). Major bleeding was the secondary outcome. The risk ratio (RR) was estimated using a random-effects model. ResultsFive randomized trials were included (1902 patients with CKD). Short DAPT (#6 months) was associated with a similar incidence of the primary outcome, compared with 12-month DAPT among patients with CKD (48 versus 50 events; RR, 0.93; 95% confidence interval [95% CI], 0.64 to 1.36; P=0.72). Twelve-month DAPT was also associated with a similar incidence of the primary outcome compared with extended DAPT ($30 months) in the CKD subgroup (35 versus 35 events; RR, 1.04; 95% CI, 0.67 to 1.62; P=0.87). Numerically lower major bleeding event rates were detected with shorter versus 12-month DAPT (9 versus 13 events; RR, 0.69; 95% CI, 0.30 to 1.60; P=0.39) and 12-month versus extended DAPT (9 versus 12 events; RR, 0.83; 95% CI, 0.35 to 1.93; P=0.66) in patients with CKD.Conclusions Short DAPT does not appear to be inferior to longer DAPT in patients with CKD and drug-eluting stents. Because of imprecision in estimates (few events and wide confidence intervals), no definite conclusions can be drawn with respect to stent thrombosis.

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Section: Introductionmentioning

confidence: 99%

Duration of Dual Antiplatelet Therapy in Patients with CKD and Drug-Eluting Stents

Mavrakanas

Chatzizisis

Gariani³

et al. 2019

CJASN

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“…Long-term DAPT reduces the risk of ischaemic relapse in patients with coronary heart disease. The benefit is particularly significant especially in patients with low risk of bleeding, where the incidence of adverse events is similar to that recorded during therapy with ASA alone 134 . Therefore, when considering long-term DAPT in the patient with coronary heart disease it is appropriate: to consider whether the patient has already followed DAPT in the past and how he or she has tolerated this treatment.…”

Section: Ischaemic and Haemorrhagic Risk In Secondary Prevention: Imentioning

confidence: 78%

Consensus Document ANMCO/ANCE/ARCA/GICR-IACPR/GISE/SICOA: Long-term Antiplatelet Therapy in Patients with Coronary Artery Disease

Gulizia

Colivicchi

Abrignani

et al. 2018

European Heart Journal Supplements

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Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the cornerstone of pharmacologic management of patients with acute coronary syndrome (ACS) and/or those receiving coronary stents. Long-term (>1 year) DAPT may further reduce the risk of stent thrombosis after a percutaneous coronary intervention (PCI) and may decrease the occurrence of non-stent-related ischaemic events in patients with ACS. Nevertheless, compared with aspirin alone, extended use of aspirin plus a P2Y12 receptor inhibitor may increase the risk of bleeding events that have been strongly linked to adverse outcomes including recurrent ischaemia, repeat hospitalisation and death. In the past years, multiple randomised trials have been published comparing the duration of DAPT after PCI and in ACS patients, investigating either a shorter or prolonged DAPT regimen. Although the current European Society of Cardiology guidelines provide a backup to individualised treatment, it appears to be difficult to identify the ideal patient profile which could safely reduce or prolong the DAPT duration in daily clinical practice. The aim of this consensus document is to review contemporary literature on optimal DAPT duration, and to guide clinicians in tailoring antiplatelet strategies in patients undergoing PCI or presenting with ACS.

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“…Also, certain agents such as Cangrelor have a short half-life leading to the immediate abrogation of their inhibitory effects within minutes following IV administration [ 49 ]. These drugs have also been associated with a significant increase in the incidence of fatal or major bleeding [ 50 ]. Glycoprotein IIb/IIIa receptor blockers have also been associated with increased risk of minor and major bleeding as well as adverse reactions affecting the cardiovascular system by inducing hypotension and bradycardia, and the circulatory system by causing thrombocytopenia [ 51 ].…”

Section: Myocardial Infarction and Nanomedicinementioning

confidence: 99%

Polymeric nanoparticles in the diagnosis and treatment of myocardial infarction: Challenges and future prospects

Karam

Fahs

Maatouk

et al. 2022

Materials Today Bio

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Antiplatelet Therapy for Long-term Secondary Prevention After Myocardial Infarction

Cited by 11 publications

References 6 publications

Duration of Dual Antiplatelet Therapy in Patients with CKD and Drug-Eluting Stents

Duration of Dual Antiplatelet Therapy in Patients with CKD and Drug-Eluting Stents

Consensus Document ANMCO/ANCE/ARCA/GICR-IACPR/GISE/SICOA: Long-term Antiplatelet Therapy in Patients with Coronary Artery Disease

Polymeric nanoparticles in the diagnosis and treatment of myocardial infarction: Challenges and future prospects

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