Platelet P2Y12 Inhibitor Monotherapy after Percutaneous Coronary Intervention: An Emerging Option for Antiplatelet Therapy De-escalation

Freek W. A. Verheugt; Kurt Huber; Peter Clemmensen; Jean-Philippe Collet; Thomas Cuisset; Felicita Andreotti

doi:10.1055/s-0042-1755330

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2023; 123(02): 159-165
DOI: 10.1055/s-0042-1755330

Theme Issue Article

Platelet P2Y12 Inhibitor Monotherapy after Percutaneous Coronary Intervention: An Emerging Option for Antiplatelet Therapy De-escalation

Freek W. A. Verheugt

¹Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands

,

Kurt Huber

²3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria

³Medical Faculty, Sigmund Freud University, Vienna, Austria

,

Peter Clemmensen

⁴Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany

⁵Department of Medicine, Nykøbing F Hospital, Nykøbing Falster, Denmark

,

Jean-Philippe Collet

⁶Sorbonne Université, ACTION Group, INSERM UMRS 1166, HÔpital Pitié-Salpêtrière (AP-HP), Institut de Cardiologie, Paris, France

,

Thomas Cuisset

⁷Department of Cardiology, La Timone Hospital, Marseille, France

,

Felicita Andreotti

⁸Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

› Author Affiliations

Abstract

Antiplatelet therapy is considered essential for secondary prevention of ischemic heart disease. After percutaneous coronary intervention (PCI), temporary dual antiplatelet therapy (DAPT), a combination consisting of aspirin and an oral P2Y12 receptor blocker, is recommended. In the long term, this strategy results in more bleeding than antiplatelet therapy with aspirin alone. Therefore, to reduce bleeding, an increasing trend has been to keep DAPT as short as clinically acceptable, after which aspirin monotherapy is continued. Another option to diminish bleeding is to discontinue aspirin at the moment of DAPT cessation after PCI, and to continue on P2Y12 blocker monotherapy. This survey reviews the evidence on P2Y12 blocker monotherapy. Some clinical guidance will be provided on when and in whom P2Y12 inhibitor monotherapy may be applied after DAPT cessation following PCI.

Keywords

aspirin - clopidogrel - ticagrelor - prasugrel - percutaneous coronary intervention

Full Text

References

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