What is the clinical evidence from this study?

Study design: Review. Population: Acute Coronary Syndrome. Intervention: Short-term DAPT followed by P2Y12 inhibitor monotherapy vs. 12-month DAPT.

January 1, 2024Open Access

Recent Evidence of Potent P2Y12 Inhibitor Monotherapy After Short-term Dual Antiplatelet Therapy for Patients With Acute Coronary Syndrome

SHSung‐Jin HongInterventional Cardiology

Key Result

Short-term dual antiplatelet therapy for 1 to 3 months followed by potent P2Y12 inhibitor monotherapy reduces major bleeding without increasing ischemic events compared to 12-month DAPT in patients with acute coronary syndrome.

Structured PICO

Does short-term DAPT followed by potent P2Y12 inhibitor monotherapy reduce major bleeding without increasing ischemic events in patients with ACS undergoing PCI?

Population

A narrative review of randomized clinical trials and meta-analyses evaluating the efficacy and safety of short-term dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy in patients with acute coronary syndrome.

Intervention

Short-term dual antiplatelet therapy (DAPT) for 1 to 3 months followed by potent P2Y12 inhibitor monotherapy (e.g., ticagrelor, prasugrel)

Comparator

12-month maintenance of dual antiplatelet therapy (DAPT) comprising aspirin and a P2Y12 inhibitor

Outcome

Major bleeding events and ischemic events (composite of death, myocardial infarction, or stroke)composite

Short-term DAPT (1-3 months) followed by potent P2Y12 inhibitor monotherapy reduces bleeding risk without increasing ischemic risk compared to standard 12-month DAPT in ACS patients undergoing PCI.

Limitations

The optimal choice of P2Y12 inhibitors in aspirin-free strategies and comparisons with other de-escalation strategies require further evaluation.

Abstract

For patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention, 12 months of dual antiplatelet therapy (DAPT) comprising aspirin and a P2Y 12 inhibitor is currently recommended as the standard treatment.However, several studies have suggested that the maintenance of DAPT for up to 12 months increases the risk of bleeding, which can be related to comorbidities and mortalities after bleeding events.Therefore, recent randomized clinical trials have indicated that short-term DAPT for 1 to 3 months followed by P2Y 12 inhibitor monotherapy is efficacious and safe compared to the 12-month maintenance of DAPT.P2Y 12 inhibitor monotherapy after short-term DAPT is associated with a lower incidence of major bleeding events without an increase in ischemic events, such as a composite of death, myocardial infarction, or stroke.This article discusses recent evidence of potent P2Y 12 inhibitor monotherapy after short-term DAPT, focusing on patients with ACS from randomized clinical trials and meta-analyses.

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