Moving from dual antiplatelet therapy to monotherapy based on P2Y12 receptor blockade-why it could be a novel paradigm?

Johny Nicolas, Ridhima Goel, Bimmer Claessen, Roxana Mehran

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

Abstract

Pivotal clinical trials conducted in the bare metal stent and first-generation drug-eluting stent (DES) eras established the superiority of dual antiplatelet therapy (DAPT) over aspirin monotherapy in preventing ischemic events. Nonetheless, recent advances in stent technology improved the safety profile of these devices, lowered the risk of stent thrombosis, and reduced the need for prolonged DAPT. Furthermore, several studies have shown that the bleeding associated with prolonged DAPT confers an increase in mortality following percutaneous coronary intervention (PCI). Hence, DAPT strategies that minimize the bleeding risk and conserve the ischemic protection became an utmost need. While several studies have shown that short DAPT durations followed by aspirin monotherapy may be safe and feasible in relatively low-risk patients, extrapolation to higher risk patients remains uncertain. Even though aspirin has been the most widely used antiplatelet drug for many decades, recent evidence suggests potential benefits with the use of P2Y12 inhibitor monotherapy after a shortened DAPT duration in patients undergoing percutaneous coronary intervention with current-generation DESs. This concept is even being taken one step further as P2Y12 inhibitor monotherapy after PCI is currently being investigated in selected patients.

Original languageEnglish
Title of host publicationDual Antiplatelet Therapy for Coronary and Peripheral Arterial Disease
PublisherElsevier
Pages167-191
Number of pages25
ISBN (Electronic)9780128205365
DOIs
StatePublished - 1 Jan 2021

Keywords

  • Aspirin
  • Bleeding
  • DAPT
  • Drug-eluting stents
  • Monotherapy
  • P2Y inhibitor
  • Prasugrel
  • Ticagrelor

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