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Demystifying the Contemporary Role of 12-Month Dual Antiplatelet Therapy After Acute Coronary Syndrome.
Valgimigli, Marco; Landi, Antonio; Angiolillo, Dominick J; Baber, Usman; Bhatt, Deepak L; Bonaca, Marc P; Capodanno, Davide; Cohen, David J; Gibson, C Michael; James, Stefan; Kimura, Takeshi; Lopes, Renato D; Mehta, Shamir R; Montalescot, Gilles; Sibbing, Dirk; Steg, P Gabriel; Stone, Gregg W; Storey, Robert F; Vranckx, Pascal; Windecker, Stephan; Mehran, Roxana.
Afiliación
  • Valgimigli M; Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland (M.V., A.L.).
  • Landi A; Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland (M.V., A.L.).
  • Angiolillo DJ; Department of Cardiology, Inselspital (S.W.), University of Bern, Switzerland (M.V.).
  • Baber U; Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland (M.V., A.L.).
  • Bhatt DL; Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland (M.V., A.L.).
  • Bonaca MP; Division of Cardiology, University of Florida College of Medicine-Jacksonville (D.J.A.).
  • Capodanno D; Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City (U.B.).
  • Cohen DJ; Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York (D.L.B.).
  • Gibson CM; Colorado Prevention Center Clinical Research, Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora (M.B.).
  • James S; Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Italy (D.C.).
  • Kimura T; St Francis Hospital, Roslyn, NY (D.J.C.).
  • Lopes RD; Cardiovascular Research Foundation, New York (D.J.C.).
  • Mehta SR; Baim Institute for Clinical Research, Harvard Medical School, Harvard University, Boston, MA (C.M.G.).
  • Montalescot G; Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Sweden (S.J.).
  • Sibbing D; Department of Cardiology, Hirakata Kohsai Hospital, Japan (T.K.).
  • Steg PG; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (R.D.L.).
  • Stone GW; Hamilton Health Sciences, Ontario, Canada (S.M.).
  • Storey RF; ACTION Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, France (G.M.).
  • Vranckx P; Deutsches Zentrum für Herz-Kreislauf-Forschung (German Center for Cardiovascular Research), partner site Munich Heart Alliance; Ludwig-Maximilians University München, Munich, Germany; and Privatklinik Lauterbacher Mühle am Ostsee, Seeshaupt, Germany (D.S.).
  • Windecker S; Paris Cité University, Public Hospitals of Paris (AP-HP), Bichat Hospital, France (P.G.S.).
  • Mehran R; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.W.S., R.M.).
Circulation ; 150(4): 317-335, 2024 Jul 23.
Article en En | MEDLINE | ID: mdl-39038086
ABSTRACT
For almost two decades, 12-month dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS) has been the only class I recommendation on DAPT in American and European guidelines, which has resulted in 12-month durations of DAPT therapy being the most frequently implemented in ACS patients undergoing percutaneous coronary intervention (PCI) across the globe. Twelve-month DAPT was initially grounded in the results of the CURE (Clopidogrel in Unstable Angina to Prevent Recurrent Events) trial, which, by design, studied DAPT versus no DAPT rather than the optimal DAPT duration. The average DAPT duration in this study was 9 months, not 12 months. Subsequent ACS studies, which were not designed to assess DAPT duration, rather its composition (aspirin with prasugrel or ticagrelor compared with clopidogrel) were further interpreted as supportive evidence for 12-month DAPT duration. In these studies, the median DAPT duration was 9 or 15 months for ticagrelor and prasugrel, respectively. Several subsequent studies questioned the 12-month regimen and suggested that DAPT duration should either be fewer than 12 months in patients at high bleeding risk or more than 12 months in patients at high ischemic risk who can safely tolerate the treatment. Bleeding, rather than ischemic risk assessment, has emerged as a treatment modifier for maximizing the net clinical benefit of DAPT, due to excessive bleeding and no clear benefit of prolonged treatment regimens in high bleeding risk patients. Multiple DAPT de-escalation treatment strategies, including switching from prasugrel or ticagrelor to clopidogrel, reducing the dose of prasugrel or ticagrelor, and shortening DAPT duration while maintaining monotherapy with ticagrelor, have been consistently shown to reduce bleeding without increasing fatal or nonfatal cardiovascular or cerebral ischemic risks compared with 12-month DAPT. However, 12-month DAPT remains the only class-I DAPT recommendation for patients with ACS despite the lack of prospectively established evidence, leading to unnecessary and potentially harmful overtreatment in many patients. It is time for clinical practice and guideline recommendations to be updated to reflect the totality of the evidence regarding the optimal DAPT duration in ACS.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Inhibidores de Agregación Plaquetaria / Síndrome Coronario Agudo / Terapia Antiplaquetaria Doble Límite: Humans Idioma: En Revista: Circulation Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Inhibidores de Agregación Plaquetaria / Síndrome Coronario Agudo / Terapia Antiplaquetaria Doble Límite: Humans Idioma: En Revista: Circulation Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos