Tailored Dual Antiplatelet Therapy After Percutaneous Coronary Intervention

Data from a meta-analysis suggest that a tailored approach can reduce adverse cardiovascular events without an increase in bleeding.

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y₁₂ inhibitor is the standard of care for patients after percutaneous coronary intervention (PCI). Various genetic polymorphisms lower absorption and hepatic activation of clopidogrel, resulting in reduced platelet inhibition in up to 30% of patients. The newer P2Y₁₂ inhibitors prasugrel and ticagrelor have more-predictable and greater platelet inhibition. Routine use of these agents compared with clopidogrel is associated with fewer thrombotic events but also with greater bleeding (NEJM JW Cardiol Dec 2020 and JAMA 2020; 324:1640). In a meta-analysis of 11 randomized and 3 observational studies (N=20,743; studies culled from over 3600 relevant articles), researchers examined the evidenc…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)