Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Nov;29(11):566-576.
doi: 10.1007/s12471-021-01582-7. Epub 2021 Jun 8.

P2Y12 blocker monotherapy after percutaneous coronary intervention

F W A Verheugt  1 , P Damman  2 , S A J Damen  2 , J J Wykrzykowska  3 , E C I Woelders  2 , R -J M van Geuns  2
Affiliations
Review

P2Y12 blocker monotherapy after percutaneous coronary intervention

F W A Verheugt et al. Neth Heart J. 2021 Nov.

Abstract

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.

Keywords: Aspirin; Clopidogrel; Percutaneous coronary intervention; Prasugrel; Ticagrelor.

PubMed Disclaimer

Conflict of interest statement

F.W.A. Verheugt has received honoraria for consulting and presentations from AstraZeneca, Bayer Healthcare and Daiichi-Sankyo. P. Damman has received consultancy fees from Philips and Abbott, and research grants from Philips, Abbott and AstraZeneca. R.-J.M. van Geuns reports personal fees from Abbott vascular, grants and personal fees from AstraZeneca, grants and personal fees from Amgen, grants and personal fees from Boston Scientific, and personal fees from Sanofi. S.A.J. Damen, J.J. Wykrzykowska and E.C.I. Woelders declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Pharmacology of antithrombotic agents in general, and of platelet P2Y12 inhibitors in particular. Reproduced from [5] with permission. 5‑HT 5 hydroxytryptamine (serotonin), ADP adenosine diphosphate
Fig. 2
Fig. 2
Vascular death, ischaemic stroke or myocardial infarction (MI) with clopidogrel versus aspirin in 19,185 vascular patients. After [16]. MI myocardial infarction, NNT/y number needed to treat per year, PAD peripheral artery disease
Fig. 3
Fig. 3
Design of the currently running HOST-EXAM trial in Korea (NCT02044250). Reproduced from [36] with permission. ACS acute coronary syndrome, DAPT dual antiplatelet platelet therapy, DES drug-eluting stent, GI gastrointestinal, MI myocardial infarction, PCI percutaneous coronary intervention, TAPT triple antiplatelet therapy, TLR target lesion revascularisation, TVR target vessel revascularisation
See this image and copyright information in PMC

References

    1. Knuuti J, Wijns W, Saraste A, et al. 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41:407–477. doi: 10.1093/eurheartj/ehz425. - DOI - PubMed
    1. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J. 2019;40:87–165. doi: 10.1093/eurheartj/ehy394. - DOI - PubMed
    1. Collet JP, Thiele H, Barbato E, et al. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2020 doi: 10.1093/eurheartj/ehaa575. - DOI - PubMed
    1. Ibanez B, James S, Agewall S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018;39:119–177. doi: 10.1093/eurheartj/ehx393. - DOI - PubMed
    1. Verheugt FWA, Ten Berg JM, Storey RF, Cuisset T, Granger CB. Antithrombotics: from aspirin to DOACs in coronary artery disease and atrial fibrillation. J Am Coll Cardiol. 2019;74:699–711. doi: 10.1016/j.jacc.2019.02.080. - DOI - PubMed

LinkOut - more resources