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Aspirin-free antiplatelet strategies after percutaneous coronary interventions.
- Source :
- European Heart Journal; 2/21/2024, Vol. 45 Issue 8, p572-585, 14p
- Publication Year :
- 2024
-
Abstract
- Dual antiplatelet therapy (DAPT) with aspirin and a platelet P2Y<subscript>12</subscript> receptor inhibitor is the standard antithrombotic treatment after percutaneous coronary interventions (PCI). Several trials have challenged guideline-recommended DAPT after PCI by testing the relative clinical effect of an aspirin-free antiplatelet approach—consisting of P2Y<subscript>12</subscript> inhibitor monotherapy after a short course (mostly 1–3 months) of DAPT—among patients undergoing PCI without a concomitant indication for oral anticoagulation (OAC). Overall, these studies have shown P2Y<subscript>12</subscript> inhibitor monotherapy after short DAPT to be associated with a significant reduction in the risk of bleeding without an increase in thrombotic or ischaemic events compared with continued DAPT. Moreover, the effects of the P2Y<subscript>12</subscript> inhibitor monotherapy without prior DAPT or following a very short course of DAPT after PCI are being investigated in emerging studies, of which one has recently reported unfavourable efficacy results associated with the aspirin-free approach compared with conventional DAPT. Finally, P2Y<subscript>12</subscript> inhibitor alone has been compared with aspirin alone as chronic therapy after DAPT discontinuation, thus challenging the historical role of aspirin as a standard of care for secondary prevention following PCI. A thorough understanding of study designs, populations, treatments, results, and limitations of trials testing P2Y<subscript>12</subscript> inhibitor monotherapy vs. DAPT or vs. aspirin is required to consider adopting this treatment in clinical practice. This review addresses the use of aspirin-free antiplatelet strategies among patients undergoing PCI without a concomitant indication for OAC, providing an overview of clinical evidence, guideline indications, practical implications, ongoing issues, and future perspectives. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 0195668X
- Volume :
- 45
- Issue :
- 8
- Database :
- Complementary Index
- Journal :
- European Heart Journal
- Publication Type :
- Academic Journal
- Accession number :
- 175621404
- Full Text :
- https://doi.org/10.1093/eurheartj/ehad876