Prasugrel Plus Aspirin Beyond 12 Months Is Associated With Improved Outcomes After Taxus Liberté Paclitaxel-Eluting Coronary Stent Placement

Garratt, Kirk N.; Weaver, W. Douglas; Jenkins, Ronald G.; Pow, Thomas; Mauri, Laura; Kereiakes, Dean J.; Winters, Kenneth J.; Christen, Thomas; Allocco, Dominic J.; Lee, David P.

doi:10.1161/circulationaha.114.013570

Cited by 64 publications

(49 citation statements)

References 28 publications

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“…Just recently, the debate about a possible rebound effect has been heated up by an observed clustering of MI within 90 days of prasugrel discontinuation in both treatment groups (12 vs 30 months prasugrel duration) in the Taxus Liberte-Post Approval substudy of the DAPT trial (156).…”

Section: Platelets Inflammation and Antiinflammatory Drugs In Acs Anmentioning

confidence: 99%

Platelets, inflammation and anti-inflammatory effects of antiplatelet drugs in ACS and CAD

Müller¹,

Chatterjee²,

Rath³

et al. 2015

Thromb Haemost

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SummaryPlatelets play a pivotal role in chronic inflammation leading to progression of atherosclerosis and acute coronary events. Recent discoveries on novel mechanisms and platelet-dependent inflammatory targets underpin the role of platelets to maintain a chronic inflammatory condition in cardiovascular disease. There is strong and clinically relevant crosslink between chronic inflammation and platelet activation. Antiplatelet therapy is a cornerstone in the prevention and treatment of acute cardiovascular events. The benefit of antiplatelet agents has mainly been attributed to their direct anti-aggregatory impact. Some anti-inflammatory off-target effects have also been described. However, it is unclear whether these effects are secondary due to inhibition of platelet activation or are caused by direct distinct mechanisms interfering with inflammatory pathways. This article will highlight novel platelet associated targets that contribute to inflammation in cardiovascular disease and elucidate mechanisms by which currently available antiplatelet agents evolve anti-inflammatory capacities, in particular by carving out the differential mechanisms directly or indirectly affecting platelet mediated inflammation. It will further illustrate the prognostic impact of antiplatelet therapies by reducing inflammatory marker release in recent cardiovascular trials.

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Section: Platelets Inflammation and Antiinflammatory Drugs In Acs Anmentioning

confidence: 99%

Platelets, inflammation and anti-inflammatory effects of antiplatelet drugs in ACS and CAD

Müller¹,

Chatterjee²,

Rath³

et al. 2015

Thromb Haemost

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“…This second part of the study, published in this issue of Circulation, 13 was also included in the randomized, double-blind DAPT Trial, which has been published in the New England Journal of Medicine. 14 The results of both studies were also recently presented and discussed at the American Heart Association Scientific Sessions.…”

Section: Long-term Secondary Prevention After High-risk Stentingmentioning

confidence: 99%

“…In the present study by Garratt et al, 13 a newer version of the paclitaxel-eluting stent was evaluated with a thinner-strut stainless steel novel cell design (97-μm struts) with a more conformable platform embedded with a durable polymer (Boston Scientific, Natick, MA). This evaluation of the TAXUS Liberté stent beyond 12 months after implantation included in the randomized, double-blind DAPT Trial represents a subset of this large trial and can be interpreted only according to the main results of the DAPT Trial.…”

Section: Long-term Secondary Prevention After High-risk Stentingmentioning

confidence: 99%

Long-Term Secondary Prevention After High-Risk Stenting

Collet¹,

Silvain²,

Montalescot³

2015

Circulation

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Editorial 13D ual antiplatelet therapy (DAPT), the combination of aspirin and an inhibitor of the platelet P2Y 12 receptor, is the foundation to prevent acute stent thrombosis (ST), the sudden thrombotic coronary occlusion that can lead to myocardial infarction or death in one third of patients. 1 The appropriate duration of DAPT in patients who have received coronary stents is an important dilemma for interventional cardiologists and a daily concern. We have entered the third decade of coronary stent implantation, the dominant strategy for myocardial revascularization, without clear guidance on the duration of DAPT.2 Professional guidelines are not entirely consistent, recommending extension of DAPT up to 6 months after implantation of a second-generation drug-eluting stent (DES) 3 or at least 12 months after implantation of a DES unless patients are at high risk for bleeding. 4 None of these guidelines recommend long-term or lifelong DAPT. The current discrepancies may reflect either a different interpretation of the data by experts of the guideline committees or, more likely, an active area of clinical investigation in which early certainties about DAPT duration after coronary stenting are being challenged. Article see p 62So far, 12 randomized, interruption studies investigating various durations of DAPT, whether short, intermediate, or prolonged (≥2 years), have been conducted (Figure). All published randomized trials to date (n>19 000) indicate no benefit of extended DAPT with clopidogrel beyond 6 or 12 months after DES but harm, 5 suggesting that the pendulum has swung back toward short DAPT duration (Table). The lack of power for important safety end points such as death, major bleeding, or ST is a common limitation of these trials. In addition, 1 randomized trial 6 and 2 registries 7,8 suggest that DAPT duration should be device specific, further adding complexity to this unresolved issue. Finally, most of the evidence has been obtained with clopidogrel, whereas more potent P2Y 12 inhibitors such as ticagrelor and prasugrel have demonstrated superiority over clopidogrel in reducing spontaneous myocardial infarction and ST after stenting.Long-term DAPT of 6 to 12 months has been recommended 9 to overcome the susceptibility of first-generation DES to ST, accounted for mainly by delayed endothelialization and polymer hypersensitivity.10 There was no randomized evidence to support this endorsement for the approved devices. The 2014 European myocardial revascularization guidelines recommend 6 months of DAPT after implantation of a new-generation DES on the basis of randomized trials demonstrating enhanced safety and effectiveness with these devices compared with their earlier counterparts.2 An even shorter duration may be used when there is a high risk of bleeding. These guidelines refer only to new-generation DES. The same guidelines also specify that DAPT may be used beyond 6 months in patients at high ischemic risk and low bleeding risk, further recognizing that prolonged DAPT may be useful and that opt...

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“…We have read the article by Garratt et al 1 with interest. It appears that the patients in this study were of lower risk with low rates of major adverse cardiac and cerebrovascular events after the initial 12 months.…”

Section: To the Editormentioning

confidence: 99%

Letter by Shah and Buch Regarding Article, “Prasugrel Plus Aspirin Beyond 12 Months Is Associated With Improved Outcomes After TAXUS Liberté Paclitaxel-Eluting Coronary Stent Placement”

Shah

Buch

2015

Circulation

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Prasugrel Plus Aspirin Beyond 12 Months Is Associated With Improved Outcomes After Taxus Liberté Paclitaxel-Eluting Coronary Stent Placement

Cited by 64 publications

References 28 publications

Platelets, inflammation and anti-inflammatory effects of antiplatelet drugs in ACS and CAD

Platelets, inflammation and anti-inflammatory effects of antiplatelet drugs in ACS and CAD

Long-Term Secondary Prevention After High-Risk Stenting

Letter by Shah and Buch Regarding Article, “Prasugrel Plus Aspirin Beyond 12 Months Is Associated With Improved Outcomes After TAXUS Liberté Paclitaxel-Eluting Coronary Stent Placement”

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