Bleeding Risk 70% Lower in Patients Who Switch Dual Antiplatelet Therapy Following ACS
Following acute coronary syndrome (ACS), switching from dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor plus aspirin to a combination of aspirin and clopidogrel was associated with decreased risk of bleeding and no increased risk of ischemic events, according to a recent study.
New P2Y12 inhibitors, in combination with aspirin, are used for first-line initial DAPT following ACS, and are often continued for 1 year, despite previous research indicating a significant bleeding risk during long-term use of the regimen.
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In their study, researchers included 646 ACS patients who underwent percutaneous coronary intervention and were treated with a new P2Y12 inhibitor plus aspirin for 1 month, and were then randomly assigned to continue treatment or to switch to 75 mg aspirin plus 75 mg clopidogrel.
Overall, the primary endpoint of death, urgent revascularization, stroke, and bleeding was 52% lower at 1 year in patients who switched to aspirin plus clopidogrel compared with those who continued treatment with the P2Y12 inhibitor plus aspirin. No difference in the rate of ischemic events was observed between the 2 DAPT regimens, but the rate of bleeding was 70% lower in patients who switched DAPT compared to those who did not.
“In patients without adverse events at one month after undergoing PCI with stenting for ACS, switched dual antiplatelet therapy is superior to unchanged DAPT in reducing bleeding events without increasing the risk of ischemic events,” the researchers concluded.
“The remaining question will be to assess which patients can be switched at 1 month and which patients should continue with ‘stronger DAPT’.”
—Michael Potts
Reference:
- EuroPCR 2017 Press Release: Switching to aspirin/clopidogrel following one month of new P2Y12 inhibitor/aspirin post-ACS [press release]. May 16, 2017. Paris France. https://www.pcronline.com/News/PCR-Press-Releases/EuroPCR-2017-Press-Release-Switching-to-aspirin-clopidogrel-following-one-month-of-new-P2Y12-inhibitor-aspirin-post-ACS.
- Cuisset T, et al. Benefit of evolutive dual antiplatelet therapy after acute coronary syndromes: the TOPIC trial [presented at EuroPCR 2017]. May 16, 2017. Paris, France.