Abstract
For secondary prevention of coronary artery disease (CAD) antiplatelet therapy is essential. For patients undergoing a percutaneous coronary intervention (PCI) temporary dual antiplatelet platelet therapy (DAPT: aspirin combined with a P2Y12 blocker) is mandatory, but leads to more bleeding than single antiplatelet therapy with aspirin. Therefore, to reduce bleeding after a PCI the duration of DAPT is usually kept as short as clinically acceptable; thereafter aspirin monotherapy is administered. Another option to reduce bleeding is to discontinue aspirin at the time of DAPT cessation and thereafter to administer P2Y12 blocker monotherapy. To date, five randomised trials have been published comparing DAPT with P2Y12 blocker monotherapy in 32,181 stented patients. Also two meta-analyses addressing this novel therapy have been presented. P2Y12 blocker monotherapy showed a 50–60% reduction in major bleeding when compared to DAPT without a significant increase in ischaemic outcomes, including stent thrombosis. This survey reviews the findings in the current literature concerning P2Y12 blocker monotherapy after PCI.
Highlights
Besides lipid lowering strategies, antithrombotic therapy is the cornerstone of secondary prevention of coronary artery disease (CAD)
For patients undergoing percutaneous coronary intervention (PCI) dual antiplatelet therapy (DAPT: aspirin combined with a P2Y12 blocker) has become the standard of care [2]
Myocardial infarction was not affected by discontinuing aspirin after DAPT cessation, nor was stent thrombosis, which occurred in less than 0.5% of the patients. These meta-analyses show that P2Y12 monotherapy is associated with less major bleeding and a similar incidence of stent thrombosis, all-cause mortality, myocardial infarction and stroke compared with prolonged DAPT. These results were seen in both stable patients as well as in those stented for acute coronary syndromes (ACS) (Tab. 2)
Summary
Antithrombotic therapy is the cornerstone of secondary prevention of coronary artery disease (CAD). Myocardial infarction was not affected by discontinuing aspirin after DAPT cessation, nor was stent thrombosis, which occurred in less than 0.5% of the patients These meta-analyses show that P2Y12 monotherapy is associated with less major bleeding and a similar incidence of stent thrombosis, all-cause mortality, myocardial infarction and stroke compared with prolonged DAPT. These results were seen in both stable patients as well as in those stented for ACS (Tab. 2)
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