Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation: an individual patient data pairwise and network meta-analysis.
Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomised controlled trials. BMJ ; : h Duration of dual antiplatelet therapy after drug-eluting stent implantation: a systematic review and meta-analysis of randomized controlled trials.
Extended duration dual antiplatelet therapy and mortality: a systematic review and meta-analysis. Lancet ; : — Mortality in patients treated with extended duration dual antiplatelet therapy after drug-eluting stent implantation: a pairwise and Bayesian network meta-analysis of randomised trials. Tradeoff between bleeding and stent thrombosis in different dual antiplatelet therapy regimes: Importance of case fatality rates and effective treatment durations.
Am Heart J ; : — Long-term use of ticagrelor in patients with prior myocardial infarction. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Supplementary material. Editor's Choice Fast Track.
Oxford Academic. Philippe Gabriel Steg. Claude Le Feuvre. Jean-Louis Georges. Didier Carrie. Xavier Dreyfus. Alain Furber. Florence Leclercq. Patrick Henry , Patrick Henry. Simon Cattan. Laurent Sebagh.
Pierre-Louis Michel. Albert Tuambilangana. Nadjib Hammoudi. Franck Boccara. Guillaume Cayla. Abdourahmane Diallo. Emmanuel Berman.
Michel Komajda. Jean-Philippe Metzger. Eric Vicaut. Revision received:. Select Format Select format. Permissions Icon Permissions. Abstract Aim. Dual antiplatelet therapy , Drug-eluting stent , Randomized trial , Clopidogrel , Bleeding , Myocardial infarction. Figure 1.
Open in new tab Download slide. Table 1 Patient baseline and procedural characteristics. P -value. Open in new tab. Table 2 Clinical outcomes. P- value. Primary composite outcome a 40 5. Figure 2. Figure 3. Table 3 Bleeding outcomes. P- value a. GUSTO moderate or severe 13 1. Google Scholar Crossref. Search ADS. Published on behalf of the European Society of Cardiology. All rights reserved. For permissions please email: journals. Issue Section:. Download all slides. Supplementary data.
Supplementary Data - zip file. Comments 2. We thank Dr Belkacem for his interesting comments. It is true that the rates of very late stent thrombosis with the latest generation DES is very low, less than 0. In the recent trials on optimal duration of dual antiplatelet therapy after DES implantation, myocardial infarctions mainly occur outside the stents implanted.
More and more, in these trials testing longer versus shorter durations of dual antiplatelet therapy, the events prevented are myocardial infarctions not related to stent thrombosis. These trials are becoming secondary prevention trials. Contrarily to the comment, we do think that the unresolved question of the optimal duration of dual antiplatelet therapy requires more appropriate and well-designed trials.
Anouar Belkacemi, Resident Cardiology. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions.
For more, visit acc. Watanabe will be available to the media in a press conference on Monday, March 18, at p. CDT in Rivergate Room. Nicole Napoli Mar 18, Share via:. Contact: Nicole Napoli, nnapoli acc. The study received funding from Abbott Vascular Japan, Co.
Media Contacts Nicole Napoli Media Center ACC. The RCA has a critical stenosis in the mid-segment. There is also an anomalous origin of the left circumflex from the right coronary ostium. His RCA had a significant amount of calcium and the balloon angioplasty did not fully open the artery second image. After rotational atherectomy, the stent was deployed and despite an almost perfect result on the angiogram, IVUS demonstrated an incomplete apposition of the stent third image.
The patient underwent high pressure angioplasty using a non-compliant balloon. The following IVUS image demonstrated a fully expanded and apposed stent with final angiogram showing no significant residual stenosis of the RCA. Thereafter, Plavix or clopidogrel was favored over Ticlid because of better tolerance and decreased risk of neutropenia. Multi center trials clearly demonstrated the benefit of using dual anti-platelet DAPT consisting of aspirin and Plavix as superior to Coumadin or aspirin alone.
We currently follow a patient who underwent coronary stenting of the circumflex coronary artery in the early 90s using the femoral approach. He stayed in the hospital for a week and developed a large groin hematoma that had to be evacuated surgically. He was discharged on aspirin and Coumadin. Fifteen years later, he presented with worsening angina and myocardial ischemia on the thallium stress test. Coronary arteriogram was scheduled as an outpatient.
He underwent percutaneous coronary intervention of his right coronary artery using a radial approach and was discharged the same afternoon on aspirin and Plavix. The CURE study demonstrated that patients presenting with acute coronary syndrome Non-STEMI and treated with a bare metal stent combined with Plavix and aspirin for up to 12 months, had reduced ischemic events unstable angina, MI or death.
Plavix combined with aspirin, called dual anti-platelet therapy or DAPT , reduce the risk of stent thrombosis which can result in myocardial infarction and death. After implantation of a bare metal stent, the risk of stent thrombosis is highest in the 1st few days to weeks after implant. For this reason , the DAPT is recommended for a minimum of 1 month.
This increased risk was attributed in part to hypersensitivity to the stent polymer, delayed arterial healing and late stent mal-apposition. As a result, the patients treated with 1st generation DES were recommended DAPT for at least 1 year to reduce risk of late and very late stent thrombosis.
Compared to aspirin alone, DAPT resulted in a reduction of death, myocardial infarction and stroke but at a cost of an increase in major bleed.
More importantly, shorter DAPT was associated with lower cause of mortality due to a lower rate of bleed related death.
0コメント