P2Y₁₂ inhibitor monotherapy in patients undergoing percutaneous coronary intervention

Davide Capodanno¹, Usman Baber², Deepak L Bhatt³, Jean-Philippe Collet⁴, George Dangas⁵, Francesco Franchi⁶, C Michael Gibson⁷, Hyeon-Cheol Gwon⁸, Adnan Kastrati⁹, Takeshi Kimura¹⁰, Pedro A Lemos¹¹, Renato D Lopes¹², Roxana Mehran⁵, Michelle L O'Donoghue¹³, Sunil V Rao¹², Fabiana Rollini⁶, Patrick W Serruys¹⁴, Philippe G Steg¹⁵, Robert F Storey¹⁶, Marco Valgimigli¹⁷, Pascal Vranckx¹⁸, Hirotoshi Watanabe¹⁰, Stephan Windecker¹⁹, Dominick J Angiolillo²⁰

Affiliations

¹ Cardio-Thoracic-Vascular and Transplant Department, Azienda Ospedaliero-Universitaria Policlinico "Gaspare Rodolico - San Marco", University of Catania, Catania, Italy.
² University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
³ Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ ACTION Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Institut de Cardiologie, Paris, France.
⁵ Icahn School of Medicine at Mount Sinai, Cardiovascular Institute, New York, NY, USA.
⁶ University of Florida College of Medicine, Jacksonville, FL, USA.
⁷ Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
⁸ Department of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
⁹ Deutsches Herzzentrum München, Cardiology and Technische Universität München, Munich, Germany.
¹⁰ Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
¹¹ Hospital Israelita Albert Einstein and Heart Institute (InCor) University of São Paulo Medical School, São Paulo, Brazil.
¹² Duke University Medical Center, The Duke Clinical Research Institute, Durham, NC, USA.
¹³ TIMI Study Group, Brigham and Women's Hospital, Boston, MA, USA.
¹⁴ The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Galway, Ireland.
¹⁵ Université de Paris, INSERM U-1148, AP-HP, Hôpital Bichat, Paris, France.
¹⁶ Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
¹⁷ Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano and Bern University Hospital, Bern, Switzerland.
¹⁸ Department of Cardiology and Critical Care Medicine, Jessaziekenhuis, Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium.
¹⁹ Department of Cardiology, Bern University Hospital, Inselspital, Bern, Switzerland.
²⁰ University of Florida College of Medicine, Jacksonville, FL, USA. dominick.angiolillo@jax.ufl.edu.

PMID: 35697777
DOI: 10.1038/s41569-022-00725-6

Review

P2Y₁₂ inhibitor monotherapy in patients undergoing percutaneous coronary intervention

Davide Capodanno et al. Nat Rev Cardiol. 2022 Dec.

. 2022 Dec;19(12):829-844.

doi: 10.1038/s41569-022-00725-6. Epub 2022 Jun 13.

Authors

Affiliations

¹ Cardio-Thoracic-Vascular and Transplant Department, Azienda Ospedaliero-Universitaria Policlinico "Gaspare Rodolico - San Marco", University of Catania, Catania, Italy.
² University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
³ Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ ACTION Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Institut de Cardiologie, Paris, France.
⁵ Icahn School of Medicine at Mount Sinai, Cardiovascular Institute, New York, NY, USA.
⁶ University of Florida College of Medicine, Jacksonville, FL, USA.
⁷ Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
⁸ Department of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
⁹ Deutsches Herzzentrum München, Cardiology and Technische Universität München, Munich, Germany.
¹⁰ Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
¹¹ Hospital Israelita Albert Einstein and Heart Institute (InCor) University of São Paulo Medical School, São Paulo, Brazil.
¹² Duke University Medical Center, The Duke Clinical Research Institute, Durham, NC, USA.
¹³ TIMI Study Group, Brigham and Women's Hospital, Boston, MA, USA.
¹⁴ The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Galway, Ireland.
¹⁵ Université de Paris, INSERM U-1148, AP-HP, Hôpital Bichat, Paris, France.
¹⁶ Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
¹⁷ Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano and Bern University Hospital, Bern, Switzerland.
¹⁸ Department of Cardiology and Critical Care Medicine, Jessaziekenhuis, Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium.
¹⁹ Department of Cardiology, Bern University Hospital, Inselspital, Bern, Switzerland.
²⁰ University of Florida College of Medicine, Jacksonville, FL, USA. dominick.angiolillo@jax.ufl.edu.

PMID: 35697777
DOI: 10.1038/s41569-022-00725-6

Abstract

For 20 years, dual antiplatelet therapy (DAPT), consisting of the combination of aspirin and a platelet P2Y₁₂ receptor inhibitor, has been the gold standard of antithrombotic pharmacology after percutaneous coronary intervention (PCI). In the past 5 years, several investigations have challenged this paradigm by testing the efficacy and safety of P2Y₁₂ inhibitor monotherapy (that is, without aspirin) following a short course of DAPT. Collectively, these studies suggested a reduction in the risk of major bleeding and no significant increase in thrombotic or ischaemic events compared with guideline-recommended DAPT. Current recommendations are evolving to inform clinical practice on the ideal candidates for P2Y₁₂ inhibitor monotherapy after PCI. Generalizing the results of studies of P2Y₁₂ inhibitor monotherapy requires a thorough understanding of their design, populations, interventions, comparators and results. In this Review, we provide an up-to-date overview on the use of P2Y₁₂ inhibitor monotherapy after PCI, including supporting pharmacodynamic and clinical evidence, practical recommendations and future directions.

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References

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1. Angiolillo, D. A., Galli, M., Collet, J.-P., Kastrati, A. & O’Donoghue, M. O. Antiplatelet therapy after percutaneous coronary intervention. EuroIntervention 17, e1371–e1396 (2022). - PubMed - DOI

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P2Y₁₂ inhibitor monotherapy in patients undergoing percutaneous coronary intervention

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P2Y₁₂ inhibitor monotherapy in patients undergoing percutaneous coronary intervention

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