Key result
P2Y12 blocker monotherapy after percutaneous coronary intervention reduced major bleeding by 50-60% compared to dual antiplatelet therapy, without a significant increase in ischemic outcomes.
Why the study?
Temporary DAPT after PCI is mandatory but increases bleeding compared with aspirin monotherapy, making P2Y12 blocker monotherapy after DAPT cessation an alternative bleeding-reduction strategy.
Does P2Y12 blocker monotherapy reduce major bleeding without increasing ischemic outcomes compared to DAPT in stented patients after PCI?
Does P2Y12 blocker monotherapy reduce major bleeding without increasing ischemic outcomes compared to DAPT in stented patients after PCI?
Hazard Ratio: 0.5 (95% CI 0.41–0.61)
In patients after PCI, dropping aspirin to use P2Y12 blocker monotherapy reduces major bleeding by 50-60% without increasing the risk of ischemic events.
Short DAPT post-PCI then aspirin monotherapy curbs bleeding; leaves open optimal personalized durations in high-risk subgroups.
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.
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Verheugt et al. (2021) conducted a review in Coronary artery disease post-percutaneous coronary intervention (n=32,181). P2Y12 blocker monotherapy vs. Dual antiplatelet therapy (DAPT) was evaluated on Bleeding (pooled estimate for acute coronary syndrome patients) (HR 0.50, 95% CI 0.41-0.61). P2Y12 blocker monotherapy after percutaneous coronary intervention reduced major bleeding by 50-60% compared to dual antiplatelet therapy, without a significant increase in ischemic outcomes.
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