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Antiplatelets After Stenting

Guest: Malcolm Bell, MD Host: Sharonne Hayes, MD Overview: In this podcast, we discuss the rationale for shortening the duration of dual antiplatelet therapy after coronary stenting and continuing P2Y12 inhibitor in preference to continuing aspirin as monotherapy. With this approach, the risk of significant bleeding is reduced significantly and with no corresponding increase in ischemic or thrombotic events. This strategy is particularly attractive for patients who are considered to be at high-risk of bleeding or who suffer an actionable bleed. A P2Y12 inhibitor appears to more efficacious for long term secondary prevention than aspirin. Questions: 1. We know that patients undergoing coronary stenting require dual antiplatelet therapy for varying durations. Recently, we have heard that of some interesting changes in the use of dual therapy so what’s new? a. Some background context b. Impact of bleeding c. Strategy of “Short DAPT” monotherapy with a P2Y12 inhibitor 2. Tell us more about Short DAPT and dropping the aspirin – this seems quite radical. Is it safe? 3. When and in which patients would you switch to monotherapy with a P2Y12 inhibitor? a. High bleeding risk patients b. Actionable bleeds c. Stable CAD vs ACS 4. Is there a particular P2Y12 inhibitor you would choose? a. Brief response 5. What do you do after 6 or 12 months of monotherapy – continue, or switch back to aspirin? a. Brief response