Long-Term P2Y
            <sub>12</sub>
            Inhibitor or Aspirin as Single Antiplatelet Therapy in Patients With Previous Percutaneous Coronary Intervention

Capodanno, Davide; Angiolillo, Dominick J.

doi:10.1161/circulationaha.122.063004

Cited by 4 publications

(1 citation statement)

References 16 publications

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“…These observations underscore the importance of maintaining DAPT for guideline-recommended durations (eg, 12 months) in high ischemic-risk settings, particularly when using a P2Y12 inhibitor with modest platelet inhibitory effects such as clopidogrel . Following this time frame, although a strategy of clopidogrel monotherapy is an attractive option, particularly for patients at both high ischemic and bleeding risk, this has never been tested …”

Section: Introductionmentioning

confidence: 99%

Extended Clopidogrel Monotherapy vs DAPT in Patients With Acute Coronary Syndromes at High Ischemic and Bleeding Risk

Li,

Wang

et al. 2024

JAMA Cardiol

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ImportancePurinergic receptor P2Y12 (P2Y12) inhibitor monotherapy after a certain period of dual antiplatelet therapy (DAPT) may be an attractive option of maintenance antiplatelet treatment for patients undergoing percutaneous coronary intervention (PCI) who are at both high bleeding and ischemic risk (birisk).ObjectiveTo determine if extended P2Y12 inhibitor monotherapy with clopidogrel is superior to ongoing DAPT with aspirin and clopidogrel after 9 to 12 months of DAPT after PCI in birisk patients with acute coronary syndromes (ACS).Design, Setting, and ParticipantsThis was a multicenter, double-blind, placebo-controlled, randomized clinical trial including birisk patients with ACS who had completed 9 to 12 months of DAPT after drug-eluting stent implantation and were free from adverse events for at least 6 months at 101 China centers between February 2018 and December 2020. Study data were analyzed from April 2023 to May 2023.InterventionsPatients were randomized either to clopidogrel plus placebo or clopidogrel plus aspirin for an additional 9 months.Main Outcomes and MeasuresThe primary end point was Bleeding Academic Research Consortium (BARC) types 2, 3, or 5 bleeding 9 months after randomization. The key secondary end point was major adverse cardiac and cerebral events (MACCE; the composite of all-cause death, myocardial infarction, stroke or clinically driven revascularization). The primary end point was tested for superiority, and the MACCE end point was tested for sequential noninferiority and superiority.ResultsA total of 7758 patients (mean [SD] age, 64.8 [9.0] years; 4575 male [59.0%]) were included in this study. The primary end point of BARC types 2, 3, or 5 bleeding occurred in 95 of 3873 patients (2.5%) assigned to clopidogrel plus placebo and 127 of 3885 patients (3.3%) assigned to clopidogrel plus aspirin (hazard ratio [HR], 0.75; 95% CI, 0.57-0.97; difference, −0.8%; 95% CI, −1.6% to −0.1%; P = .03). The incidence of MACCE was 2.6% (101 of 3873 patients) in the clopidogrel plus placebo group and 3.5% (136 of 3885 patients) in the clopidogrel plus aspirin group (HR, 0.74; 95% CI, 0.57-0.96; difference, −0.9%; 95% CI, −1.7% to −0.1%; P &lt; .001 for noninferiority; P = .02 for superiority).Conclusions and RelevanceAmong birisk patients with ACS who completed 9 to 12 months of DAPT after drug-eluting stent implantation and were free from adverse events for at least 6 months before randomization, an extended 9-month clopidogrel monotherapy regimen was superior to continuing DAPT with clopidogrel in reducing clinically relevant bleeding without increasing ischemic events.Trial RegistrationClinicalTrials.gov Identifier: NCT03431142

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Section: Introductionmentioning

confidence: 99%

Extended Clopidogrel Monotherapy vs DAPT in Patients With Acute Coronary Syndromes at High Ischemic and Bleeding Risk

Li,

Wang

et al. 2024

JAMA Cardiol

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Evaluating the pharmacokinetic and pharmacodynamic impact of different modes of ticagrelor administration

Spagnolo,

Angiolillo,

Capodanno

2023

Expert Opinion on Drug Metabolism & Toxicology

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Personalised antiplatelet therapies for coronary artery disease: what the future holds

Capodanno

Angiolillo

2023

European Heart Journal

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Coronary artery disease (CAD) is one of the leading causes of death globally, and antiplatelet therapy is crucial for both its prevention and treatment. Antiplatelet drugs such as aspirin and P2Y12 inhibitors are commonly used to reduce the risk of thrombotic events, including myocardial infarction, stroke, and stent thrombosis. However, the benefits associated with the use of antiplatelet drugs also come with a risk of bleeding complications. The ever-growing understanding of the poor prognostic implications associated with bleeding has set the foundations for defining strategies that can mitigate such safety concern without any trade-off in antithrombotic protection. To this extent, personalised antiplatelet therapy has emerged as a paradigm that optimizes the balance between safety and efficacy by customizing treatment to the individual patient's needs and risk profile. Accurate risk stratification for both bleeding and thrombosis can aid in selecting the optimal antiplatelet therapy and prevent serious and life-threatening outcomes. Risk stratification has traditionally included clinical and demographic characteristics and has expanded to incorporate angiographic features and laboratory findings. The availability of bedside platelet function testing as well as rapid genotyping assays has also allowed for a more individualized selection of antiplatelet therapy. This review provides a comprehensive overview of the current state of the art and future trends in personalised antiplatelet therapy for patients with CAD, with emphasis on those presenting with an acute coronary syndrome and undergoing percutaneous coronary revascularization. The aim is to provide clinicians with a comprehensive understanding of personalised antiplatelet therapy and facilitate informed clinical decision-making.

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Long-Term P2Y ₁₂ Inhibitor or Aspirin as Single Antiplatelet Therapy in Patients With Previous Percutaneous Coronary Intervention

Cited by 4 publications

References 16 publications

Extended Clopidogrel Monotherapy vs DAPT in Patients With Acute Coronary Syndromes at High Ischemic and Bleeding Risk

Extended Clopidogrel Monotherapy vs DAPT in Patients With Acute Coronary Syndromes at High Ischemic and Bleeding Risk

Evaluating the pharmacokinetic and pharmacodynamic impact of different modes of ticagrelor administration

Personalised antiplatelet therapies for coronary artery disease: what the future holds

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Long-Term P2Y 12 Inhibitor or Aspirin as Single Antiplatelet Therapy in Patients With Previous Percutaneous Coronary Intervention

Cited by 4 publications

References 16 publications

Extended Clopidogrel Monotherapy vs DAPT in Patients With Acute Coronary Syndromes at High Ischemic and Bleeding Risk

Extended Clopidogrel Monotherapy vs DAPT in Patients With Acute Coronary Syndromes at High Ischemic and Bleeding Risk

Evaluating the pharmacokinetic and pharmacodynamic impact of different modes of ticagrelor administration

Personalised antiplatelet therapies for coronary artery disease: what the future holds

Contact Info

Product

Resources

About

Long-Term P2Y ₁₂ Inhibitor or Aspirin as Single Antiplatelet Therapy in Patients With Previous Percutaneous Coronary Intervention