Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk

Valgimigli, Marco; Frigoli, Enrico; Heg, Dik; Tijssen, Jan G.P.; Jüni, Peter; Vranckx, Pascal; Ozaki, Yukio; Morice, Marie‐Claude; Chevalier, Bernard; Onuma, Yoshinobu; Windecker, Stephan; Tonino, Pim A.L.; Roffi, Marco; Lesiak, Maciej; Mahfoud, Felix; Bartúnek, Jozef; Hildick‐Smith, David; Colombo, Antonio; Stanković, Goran; Íñiguez, Andrés; Schultz, Carl; Kornowski, Ran; Ong, Paul J.L.; Alasnag, Mirvat; Rodríguez, Alfredo E.; Moschovitis, Aris; Laanmets, Peep; Donahue, Michael; Leonardi, Sergio; Smits, Pieter C.

doi:10.1056/nejmoa2108749

Cited by 349 publications

(274 citation statements)

References 18 publications

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“…Evidence supported strategies to reduce bleeding events after PCI include shorter DAPT duration, de-escalation of potent P2Y12 inhibitors, and ulcer prophylaxis with proton pump inhibitors. [31][32][33][34][35][36] Physicians should judiciously place a higher priority on employment of these strategies for Chinese or East Asian patients.…”

Section: Discussionmentioning

confidence: 99%

Trade-off of major bleeding versus myocardial infarction on mortality after percutaneous coronary intervention

et al. 2022

Open Heart

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BackgroundThe choice of antithrombotic therapy after percutaneous coronary intervention (PCI) is heavily dependent on the relative trade-off between major bleeding (MB) and myocardial infarction (MI). However, the mortality trade-off was mostly described in Western populations and remained unknown in East Asians.MethodThis was a retrospective cohort study from 14 hospitals under the Hospital Authority of Hong Kong between 2004 and 2017. Participants were patients undergoing first-time PCI and survived for the first year. Patients were stratified by the presence of MB and MI during the first year. The primary endpoint was all-cause mortality between 1 and 5 years after PCI. The secondary endpoint was cardiovascular mortality.ResultsA total of 32 180 patients were analysed. After adjustment for baseline characteristics and using patients with neither events as reference, the risks of all-cause mortality were increased in patients with MI only (HR, 1.63; 95% CI 1.45 to 1.84; p<0.001), further increased in those with MB only (HR, 2.11, 95% CI 1.86 to 2.39; p<0.001) and highest in those with both (HR, 2.92; 95% CI 2.39 to 3.56; p<0.001). In both Cox regression and propensity score analyses, MB had a stronger impact on all-cause mortality than MI, but similar impact on cardiovascular mortality.ConclusionsBoth MB and MI within the first year after PCI were associated with increase in all-cause and cardiovascular mortality in Chinese patients, but the impact was stronger with MB.

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Section: Discussionmentioning

confidence: 99%

Trade-off of major bleeding versus myocardial infarction on mortality after percutaneous coronary intervention

et al. 2022

Open Heart

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“…La reducción de la TAPD tiene especial relevancia en pacientes con alto riesgo de sangrado. El estudio MASTER-DAPT (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated vs. Standard Dual Antiplatelet Therapy Regimen), realizado en este tipo de pacientes con SCA tratados con stent de polímero biodegradable, evaluó mantener la TAPD durante un mes frente a la duración estándar 14 . La pauta corta de TAPD resultó no inferior a la estándar en términos de eventos isquémicos, con una reducción significativa de sangrados.…”

Section: Nuevas Estrategias En La Duración Del Tratamiento Antitrombó...unclassified

Tendencias actuales en el tratamiento antitrombótico

et al. 2022

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Los fármacos antitrombóticos son un pilar fundamental en el tratamiento y prevención de las enfermedades cardiovasculares. A pesar de la amplia experiencia previa, en los últimos años se han producido importantes novedades en la práctica clínica que han modificado estrategias terapéuticas en diferentes escenarios como en el campo de la fibrilación auricular, la cardiopatía isquémica o el intervencionismo coronario percutáneo. A todo esto se debe que añadir el papel fundamental del tratamiento antitrombótico durante la reciente pandemia de COVID-19 y sus implicaciones dado el estado protrombótico que produce la infección por el virus SARS-CoV-2. Desde el Grupo de Trabajo de Trombosis Cardiovascular de la Sociedad Española de Cardiología, se ha sintetizado la evidencia científica reciente en el presente documento.

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“…However, in less compliant patients, prasugrel remains the preferred antiplatelet of choice due to its once-daily dosing as compared to the twice-daily ticagrelor regimen. While ticagrelor has been studied as a single, monotherapy agent for ACS patients in the MASTER DAPT and GLOBAL Leaders investigator trials, the data for prasugrel monotherapy is less august [ 11 , 12 ]. In order to better inform the debate on what should constitute the optimal antiplatelet agent, both the drugs should be studied in a head-to-head, comparative fashion in stable ACS patients undergoing PCI.…”

Section: Future Perspectivesmentioning

confidence: 99%