Antiplatelet treatment, dyslipidemia, cardiac side events during COVID-19 vaccine, antithrombotic treatment with different BMI

In this issue of the journal, we have some Pharmapulse reports from the great ESC meeting in London. Elderly individuals account for about one-third of patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).1 Their representation is rapidly increasing in view of the demographic shift in the population age and the growing preference for PCI over medical therapy in older patients. Dual antiplatelet therapy (DAPT), including aspirin and an oral P2Y12 receptor inhibitor, remains the default strategy for antithrombotic therapy during the early phase of ACS.2 Strategies to reduce DAPT-related bleeding include abbreviation of DAPT duration and de-escalation of DAPT intensity, consisting of a guided or unguided downgrading from a potent to a less potent P2Y12 receptor inhibitor (from ticagrelor 90 mg to ticagrelor 60 mg twice a day).3 PLINY The ELDER4 was a randomized, crossover trial testing the non-inferiority of a lower vs. standard dose of ticagrelor with respect to the primary endpoint of P2Y12 inhibition in 50 patients as determined by pre-dose P2Y12 reaction units using the VerifyNow-P2Y12. Dr Piccolo and co-workers from Italy reported that ACS patients aged 75 years or more undergoing PCI, showed that ticagrelor 60 mg twice daily provides a similar magnitude of platelet inhibition compared with ticagrelor 90 mg twice daily. These results may support the hypothesis that the lower ticagrelor dose can be equally effective than the standard dose in the acute phase of ACS. The benefits of DAPT are offset by an increase in bleeding, a complication closely associated with mortality.5 After an ACS or PCI, the risk of ischaemic events is initially high (i.e. 1–3 months) and gradually decreases thereafter, while the risk of bleeding tends to remain stable over time.6 Dr Galli et al. used randomized controlled trials comparing P2Y12 inhibitor monotherapy after a short course of DAPT (≤3 months) vs. 12-month DAPT in ACS were included.7–9,7,10 In patients with ACS, P2Y12 inhibitor monotherapy after short DAPT halves bleeding without increasing ischaemic events compared with standard DAPT. Ticagrelor, but not clopidogrel monotherapy, reduced MACE and mortality compared with standard DAPT, supporting its use after aspirin discontinuation. The study group reported that in patients with ACS, P2Y12 inhibitor monotherapy after short DAPT halves bleeding without increasing ischaemic events compared with standard DAPT. Ticagrelor, but not clopidogrel monotherapy, reduced MACE and mortality compared with standard DAPT, supporting its use after aspirin discontinuation. Vaccination is probably the top achievement of public health in the 20th century. Vaccination against Coronavirus disease 2019 (COVID-19) has significantly reduced the likelihood of hospitalization and deaths resulting from SARS-CoV-2 infection.11,12 The benefit of active immunization against COVID-19 substantially outweighs the potential risk of postvaccination severe adverse drug reactions (ADRs).11,12 However, there has been and still exist people who are against all kinds of vaccination and conspiracy theories and Covid-19 medical misinformation are spread at internet. Of course, all kind of medical interventions have side effects.13 In this issue of the journal, suspected Adverse Drug Reports to COVID-19 vaccines reported to the EudraVigilance database14 were analysed by Nazar et al. Their report concluded that the frequency of most of the suspected serious cardiac ADRs appears to be very rare and showed the high safety of COVID-19 vaccines. Inoculation with Comirnaty and Spikevax (mRNA vaccines) seemed to be associated with the lowest risk of potential serious cardiac ADRs. During the last decade several new options for treatment of dyslipidaemia have been available on the market.15–29 We publish a review paper by Dr Drexel et al., entitled ‘Management of dyslipidaemia in patients with comorbidities—facing the challenge’. The paper focus on dyslipidaemia patients with chronic kidney disease, but not on dialysis or after renal transplantation. We are also happy to publish a paper entitled ‘Update on Antithrombotic therapy and body mass. A Clinical Consensus Statement of the ESC Working Group on Cardiovascular Pharmacotherapy and the ESC Working Group on Thrombosis’ by Dr Rocca and co-workers.30