Often the topic is the subject of ongoing investigation. ...the reader should view ECDs as the best attempt of the ACCF and other cosponsors to inform and guide clinical practice in areas where ...rigorous evidence may not be available or the evidence to date is not widely accepted. The COX-1 pathway is the predominant constitutive pathway; prostaglandins derived from this enzyme mediate many effects, most notably facilitating gastroduodenal cytoprotection, renal perfusion, and platelet activity.\n Peer Reviewer Representation Consulting Fees/Honoraria Speakers' Bureau Ownership/Partnership/Principal Research Institutional or Other Financial Benefit Expert Witness or Consultant Dr. Eric R. Bates Official Reviewer--ACCF Task Force on Expert Consensus Documents * Sanofi-Aventis None None None None None Dr. Craig B. Clark Official Reviewer--ACCF Board of Governors None None None None None None Dr. Robert A. Harrington Official Reviewer--ACCF Board of Trustees Bayer* Bristol-Myers Squibb Sanofi-Aventis None None AstraZeneca* Bayer* Bristol-Myers Squibb* Sanofi-Aventis* None None Dr. John Inadomi Official Reviewer--ACG AstraZeneca TAP Pharmaceuticals None None None None None Dr. Philip Katz Official Reviewer--ACG AstraZeneca* Horizon Therapeutics TAP Pharmaceuticals AstraZeneca* Santarus TAP Pharmaceuticals None None None None Dr. Laurence Sperling Official Reviewer--AHA None None None None None None Dr. Daniel I. Simon Official Reviewer--AHA * Sanofi-Aventis None None None None None Dr. Jeffrey S. Berger Content Reviewer--ACCF Prevention Committee None None None None None None Dr. Roger S. Blumenthal Content Reviewer--ACCF Prevention Committee None None None None None None Dr. Jeffrey J. Cavendish Content Reviewer--ACCF Prevention Committee None * Bristol-Myers Squibb/Sanofi-Aventis* None None None None Dr. Jose G. Diez Content Reviewer--ACCF Cardiac Catheterization and Intervention Committee * Sanofi-Aventis None * Sanofi-Aventis None None None Dr. Steven P. Dunn Content Reviewer--ACCF Prevention Committee None None None None None None Dr. Pamela B. Morris Content Reviewer--ACCF Prevention Committee AstraZeneca Pfizer Takeda Pharmaceuticals North America None None None None None Dr. Srihari S. Naidu Content Reviewer--ACCF Cardiac Catheterization and Intervention Committee None None None None None None Dr. Robert S. Rosenson Content Reviewer--ACCF Task Force on Clinical Expert Consensus Documents None * AstraZeneca* None * AstraZeneca* None None Dr. Nanette K. Wenger Content Reviewer--ACC/AHA Guidelines on the Management of Patients With Unstable Angina/NSTEMI AstraZeneca Pfizer Schering-Plough* None None Pfizer* Sanofi-Aventis* None None Ms. Marie J. Williams Content Reviewer--ACCF Cardiac Catheterization and Intervention Committee None None None None None None * This table represents the relationships of peer reviewers with industry and other entities that were reported as relevant to this topic during the document development process.
In the TWILIGHT trial, ticagrelor monotherapy after a short course of dual antiplatelet therapy (DAPT) was shown to be a safe bleeding avoidance strategy in high-risk patients undergoing percutaneous ...coronary intervention (PCI) with drug-eluting stents (DES).
The aim of this study was to evaluate the effects of ticagrelor monotherapy after three-month DAPT in patients undergoing PCI, according to DES type.
In the current sub-analysis from TWILIGHT, patients were stratified into three groups based on DES type: durable polymer everolimus-eluting stents (DP-EES), durable polymer zotarolimus-eluting stents (DP-ZES), and biodegradable polymer DES (BP-DES). Bleeding and ischaemic outcomes were assessed at one year after randomisation.
Out of 5,769 patients, 3,014 (52.2%) had DP-EES, 1,350 (23.4%) had DP-ZES and 1,405 (24.4%) had BP-DES. Compared with ticagrelor plus aspirin, ticagrelor monotherapy had significantly lower BARC type 2, 3 or 5 bleeding compared with DAPT; DP-EES (3.8% vs 6.7%; HR 0.56, 95% CI: 0.41-0.78), DP-ZES (4.6% vs 6.9%; HR 0.66, 95% CI: 0.42-1.04) and BP-DES (4.2% vs 7.9%; HR 0.52, 95% CI: 0.33-0.81; p
=0.76). Ticagrelor monotherapy resulted in similar rates of death, MI, or stroke: DP-EES (4.2% vs 4.3%; HR 0.97; 95% CI: 0.68-1.37); DP-ZES (4.1% vs 3.1%; HR 1.32; 95% CI: 0.75-2.33); BP-DES (3.9% vs 4.2%; HR 0.92; 95% CI: 0.54-1.55; p
=0.60). In both unadjusted and covariate-adjusted analyses, DES type was not associated with any differences in ischaemic or bleeding complications.
As compared with ticagrelor plus aspirin, ticagrelor monotherapy after a short DAPT duration lowered bleeding complications without increasing the ischaemic risk, irrespective of DES type. We observed no significant differences among DES types.
Dual antiplatelet therapy with aspirin and a thienopyridine has been shown to reduce cardiac events after coronary stenting. However, many patients and healthcare providers prematurely discontinue ...dual antiplatelet therapy, which greatly increases the risk of stent thrombosis, myocardial infarction, and death. This advisory stresses the importance of 12 months of dual antiplatelet therapy after placement of a drug-eluting stent and educating the patient and healthcare providers about hazards of premature discontinuation. It also recommends postponing elective surgery for 1 year, and if surgery cannot be deferred, considering the continuation of aspirin during the perioperative period in high-risk patients with drug-eluting stents.
PDF
