The Management and Antithrombotic Strategies of Patients with Coronary Artery Disease and High Bleeding Risk

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Zurück zum Zitat Raposeiras-Roubin S, Faxen J, Iniguez-Romo A, Henriques JPS, D’Ascenzo F, Saucedo J, Szummer K, Jernberg T, James SK, Juanatey JRG, et al. Development and external validation of a post-discharge bleeding risk score in patients with acute coronary syndrome: The BleeMACS score. Int J Cardiol. 2018;254:10–5.PubMedCrossRef Raposeiras-Roubin S, Faxen J, Iniguez-Romo A, Henriques JPS, D’Ascenzo F, Saucedo J, Szummer K, Jernberg T, James SK, Juanatey JRG, et al. Development and external validation of a post-discharge bleeding risk score in patients with acute coronary syndrome: The BleeMACS score. Int J Cardiol. 2018;254:10–5.PubMedCrossRef

Zurück zum Zitat Natsuaki M, Morimoto T, Yamaji K, Watanabe H, Yoshikawa Y, Shiomi H, Nakagawa Y, Furukawa Y, Kadota K, Ando K, et al. Prediction of thrombotic and bleeding events after percutaneous coronary intervention: CREDO-Kyoto thrombotic and bleeding risk scores. J Am Heart Assoc. 2018;7(11). Natsuaki M, Morimoto T, Yamaji K, Watanabe H, Yoshikawa Y, Shiomi H, Nakagawa Y, Furukawa Y, Kadota K, Ando K, et al. Prediction of thrombotic and bleeding events after percutaneous coronary intervention: CREDO-Kyoto thrombotic and bleeding risk scores. J Am Heart Assoc. 2018;7(11).

Zurück zum Zitat Subherwal S, Bach RG, Chen AY, Gage BF, Rao SV, Newby LK, Wang TY, Gibler WB, Ohman EM, Roe MT, et al. Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) Bleeding Score. Circulation. 2009;119(14):1873–82.PubMedPubMedCentralCrossRef Subherwal S, Bach RG, Chen AY, Gage BF, Rao SV, Newby LK, Wang TY, Gibler WB, Ohman EM, Roe MT, et al. Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) Bleeding Score. Circulation. 2009;119(14):1873–82.PubMedPubMedCentralCrossRef

Zurück zum Zitat Yeh RW, Secemsky EA, Kereiakes DJ, Normand SL, Gershlick AH, Cohen DJ, Spertus JA, Steg PG, Cutlip DE, Rinaldi MJ, et al. Development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention. JAMA. 2016;315(16):1735–49.PubMedPubMedCentralCrossRef Yeh RW, Secemsky EA, Kereiakes DJ, Normand SL, Gershlick AH, Cohen DJ, Spertus JA, Steg PG, Cutlip DE, Rinaldi MJ, et al. Development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention. JAMA. 2016;315(16):1735–49.PubMedPubMedCentralCrossRef

Zurück zum Zitat Baber U, Mehran R, Giustino G, Cohen DJ, Henry TD, Sartori S, Ariti C, Litherland C, Dangas G, Gibson CM, et al. Coronary thrombosis and major bleeding after PCI with drug-eluting stents: risk scores from PARIS. J Am Coll Cardiol. 2016;67(19):2224–34.PubMedCrossRef Baber U, Mehran R, Giustino G, Cohen DJ, Henry TD, Sartori S, Ariti C, Litherland C, Dangas G, Gibson CM, et al. Coronary thrombosis and major bleeding after PCI with drug-eluting stents: risk scores from PARIS. J Am Coll Cardiol. 2016;67(19):2224–34.PubMedCrossRef

Zurück zum Zitat Costa F, van Klaveren D, James S, Heg D, Raber L, Feres F, Pilgrim T, Hong MK, Kim HS, Colombo A, et al. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet. 2017;389(10073):1025–34.PubMedCrossRef Costa F, van Klaveren D, James S, Heg D, Raber L, Feres F, Pilgrim T, Hong MK, Kim HS, Colombo A, et al. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet. 2017;389(10073):1025–34.PubMedCrossRef

Zurück zum Zitat Ducrocq G, Wallace JS, Baron G, Ravaud P, Alberts MJ, Wilson PW, Ohman EM, Brennan DM, D’Agostino RB, Bhatt DL, et al. Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis. Eur Heart J. 2010;31(10):1257–65.PubMedCrossRef Ducrocq G, Wallace JS, Baron G, Ravaud P, Alberts MJ, Wilson PW, Ohman EM, Brennan DM, D’Agostino RB, Bhatt DL, et al. Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis. Eur Heart J. 2010;31(10):1257–65.PubMedCrossRef

Zurück zum Zitat Erlinge D, Omerovic E, Frobert O, Linder R, Danielewicz M, Hamid M, Swahn E, Henareh L, Wagner H, Hardhammar P, et al. Bivalirudin versus heparin monotherapy in myocardial infarction. N Engl J Med. 2017;377(12):1132–42.PubMedCrossRef Erlinge D, Omerovic E, Frobert O, Linder R, Danielewicz M, Hamid M, Swahn E, Henareh L, Wagner H, Hardhammar P, et al. Bivalirudin versus heparin monotherapy in myocardial infarction. N Engl J Med. 2017;377(12):1132–42.PubMedCrossRef

Zurück zum Zitat Valgimigli M, Frigoli E, Leonardi S, Vranckx P, Rothenbuhler M, Tebaldi M, Varbella F, Calabro P, Garducci S, Rubartelli P, et al. Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial. Lancet. 2018;392(10150):835–48.PubMedCrossRef Valgimigli M, Frigoli E, Leonardi S, Vranckx P, Rothenbuhler M, Tebaldi M, Varbella F, Calabro P, Garducci S, Rubartelli P, et al. Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial. Lancet. 2018;392(10150):835–48.PubMedCrossRef

Zurück zum Zitat Jovin IS, Shah RM, Patel DB, Rao SV, Baklanov DV, Moussa I, Kennedy KF, Secemsky EA, Yeh RW, Kontos MC, et al. Outcomes in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction via radial access anticoagulated with bivalirudin versus heparin: a report from the National Cardiovascular Data Registry. JACC Cardiovasc Interv. 2017;10(11):1102–11.PubMedCrossRef Jovin IS, Shah RM, Patel DB, Rao SV, Baklanov DV, Moussa I, Kennedy KF, Secemsky EA, Yeh RW, Kontos MC, et al. Outcomes in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction via radial access anticoagulated with bivalirudin versus heparin: a report from the National Cardiovascular Data Registry. JACC Cardiovasc Interv. 2017;10(11):1102–11.PubMedCrossRef

Zurück zum Zitat Nikolsky E, Mehran R, Dangas G, Fahy M, Na Y, Pocock SJ, Lincoff AM, Stone GW. Development and validation of a prognostic risk score for major bleeding in patients undergoing percutaneous coronary intervention via the femoral approach. Eur Heart J. 2007;28(16):1936–45.PubMedCrossRef Nikolsky E, Mehran R, Dangas G, Fahy M, Na Y, Pocock SJ, Lincoff AM, Stone GW. Development and validation of a prognostic risk score for major bleeding in patients undergoing percutaneous coronary intervention via the femoral approach. Eur Heart J. 2007;28(16):1936–45.PubMedCrossRef

Zurück zum Zitat Alba AC, Guyatt G. In patients receiving DAPT after coronary stents, the PRECISE-DAPT score predicted bleeding moderately well. Ann Intern Med 2017;167(2):JC11. Alba AC, Guyatt G. In patients receiving DAPT after coronary stents, the PRECISE-DAPT score predicted bleeding moderately well. Ann Intern Med 2017;167(2):JC11.

Zurück zum Zitat Choi KH, Song YB, Lee JM, Park TK, Yang JH, Choi JH, Choi SH, Oh JH, Cho DK, Lee JB, et al. Clinical usefulness of PRECISE-DAPT score for predicting bleeding events in patients with acute coronary syndrome undergoing percutaneous coronary intervention: an analysis from the SMART-DATE randomized trial. Circ Cardiovasc Interv. 2020;13(5): e008530.PubMedCrossRef Choi KH, Song YB, Lee JM, Park TK, Yang JH, Choi JH, Choi SH, Oh JH, Cho DK, Lee JB, et al. Clinical usefulness of PRECISE-DAPT score for predicting bleeding events in patients with acute coronary syndrome undergoing percutaneous coronary intervention: an analysis from the SMART-DATE randomized trial. Circ Cardiovasc Interv. 2020;13(5): e008530.PubMedCrossRef

Zurück zum Zitat Urban P, Mehran R, Colleran R, Angiolillo DJ, Byrne RA, Capodanno D, Cuisset T, Cutlip D, Eerdmans P, Eikelboom J, et al. Defining high bleeding risk in patients undergoing percutaneous coronary intervention. Circulation. 2019;140(3):240–61.PubMedPubMedCentralCrossRef Urban P, Mehran R, Colleran R, Angiolillo DJ, Byrne RA, Capodanno D, Cuisset T, Cutlip D, Eerdmans P, Eikelboom J, et al. Defining high bleeding risk in patients undergoing percutaneous coronary intervention. Circulation. 2019;140(3):240–61.PubMedPubMedCentralCrossRef

Zurück zum Zitat Collet JP, Thiele H, Barbato E, Barthelemy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289–367.PubMedCrossRef Collet JP, Thiele H, Barbato E, Barthelemy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289–367.PubMedCrossRef

Zurück zum Zitat Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, Kaul S, Wiviott SD, Menon V, Nikolsky E, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123(23):2736–47.PubMedCrossRef Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, Kaul S, Wiviott SD, Menon V, Nikolsky E, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123(23):2736–47.PubMedCrossRef

Zurück zum Zitat Strauss CE, Porten BR, Chavez IJ, Garberich RF, Chambers JW, Baran KW, Poulose AK, Henry TD. Real-time decision support to guide percutaneous coronary intervention bleeding avoidance strategies effectively changes practice patterns. Circ Cardiovasc Qual Outcomes. 2014;7(6):960–7.PubMedCrossRef Strauss CE, Porten BR, Chavez IJ, Garberich RF, Chambers JW, Baran KW, Poulose AK, Henry TD. Real-time decision support to guide percutaneous coronary intervention bleeding avoidance strategies effectively changes practice patterns. Circ Cardiovasc Qual Outcomes. 2014;7(6):960–7.PubMedCrossRef

Zurück zum Zitat Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, Juni P, Kastrati A, Kolh P, Mauri L, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018;39(3):213–60.PubMedCrossRef Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, Juni P, Kastrati A, Kolh P, Mauri L, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018;39(3):213–60.PubMedCrossRef

Zurück zum Zitat Watanabe H, Domei T, Morimoto T, Natsuaki M, Shiomi H, Toyota T, Ohya M, Suwa S, Takagi K, Nanasato M, et al. Effect of 1-month dual antiplatelet therapy followed by clopidogrel vs 12-month dual antiplatelet therapy on cardiovascular and bleeding events in patients receiving PCI: the STOPDAPT-2 randomized clinical trial. JAMA. 2019;321(24):2414–27.PubMedCentralCrossRef Watanabe H, Domei T, Morimoto T, Natsuaki M, Shiomi H, Toyota T, Ohya M, Suwa S, Takagi K, Nanasato M, et al. Effect of 1-month dual antiplatelet therapy followed by clopidogrel vs 12-month dual antiplatelet therapy on cardiovascular and bleeding events in patients receiving PCI: the STOPDAPT-2 randomized clinical trial. JAMA. 2019;321(24):2414–27.PubMedCentralCrossRef

Zurück zum Zitat Mehran R, Baber U, Sharma SK, Cohen DJ, Angiolillo DJ, Briguori C, Cha JY, Collier T, Dangas G, Dudek D, et al. Ticagrelor with or without aspirin in high-risk patients after PCI. N Engl J Med. 2019;381(21):2032–42.PubMedCrossRef Mehran R, Baber U, Sharma SK, Cohen DJ, Angiolillo DJ, Briguori C, Cha JY, Collier T, Dangas G, Dudek D, et al. Ticagrelor with or without aspirin in high-risk patients after PCI. N Engl J Med. 2019;381(21):2032–42.PubMedCrossRef

Zurück zum Zitat Zhang J, Qiu M, Na K, Ma S, Jiang Z, Li J, Li Y, Han Y. Impact of 6- versus 12-month dual antiplatelet therapy on clinical prognosis in patients with high bleeding risk: Insights from the 4-year results of the I LOVE IT 2 study. Catheter Cardiovasc Interv. 2021;97(Suppl 2):1025–31.PubMedCrossRef Zhang J, Qiu M, Na K, Ma S, Jiang Z, Li J, Li Y, Han Y. Impact of 6- versus 12-month dual antiplatelet therapy on clinical prognosis in patients with high bleeding risk: Insights from the 4-year results of the I LOVE IT 2 study. Catheter Cardiovasc Interv. 2021;97(Suppl 2):1025–31.PubMedCrossRef

Zurück zum Zitat •• Valgimigli M, Frigoli E, Heg D, Tijssen J, Juni P, Vranckx P, Ozaki Y, Morice MC, Chevalier B, Onuma Y, et al. Dual antiplatelet therapy after PCI in patients at high bleeding risk. N Engl J Med 2021;385(18):1643–1655. Findings from this study suggest that for patients at high risk of bleeding after PCI, one month of dual antiplatelet therapy is not inferior to continuing treatment for at least 2 months; it also reduces the incidence of major bleeding or clinically relevant non-major bleeding. •• Valgimigli M, Frigoli E, Heg D, Tijssen J, Juni P, Vranckx P, Ozaki Y, Morice MC, Chevalier B, Onuma Y, et al. Dual antiplatelet therapy after PCI in patients at high bleeding risk. N Engl J Med 2021;385(18):1643–1655. Findings from this study suggest that for patients at high risk of bleeding after PCI, one month of dual antiplatelet therapy is not inferior to continuing treatment for at least 2 months; it also reduces the incidence of major bleeding or clinically relevant non-major bleeding.

Zurück zum Zitat Kirtane AJ, Stoler R, Feldman R, Neumann FJ, Boutis L, Tahirkheli N, Toelg R, Othman I, Stein B, Choi JW, et al. Primary results of the EVOLVE short DAPT study: evaluation of 3-month dual antiplatelet therapy in high bleeding risk patients treated with a bioabsorbable polymer-coated everolimus-eluting stent. Circ Cardiovasc Interv. 2021;14(3): e010144.PubMedCrossRef Kirtane AJ, Stoler R, Feldman R, Neumann FJ, Boutis L, Tahirkheli N, Toelg R, Othman I, Stein B, Choi JW, et al. Primary results of the EVOLVE short DAPT study: evaluation of 3-month dual antiplatelet therapy in high bleeding risk patients treated with a bioabsorbable polymer-coated everolimus-eluting stent. Circ Cardiovasc Interv. 2021;14(3): e010144.PubMedCrossRef

Zurück zum Zitat • Mehran R, Cao D, Angiolillo DJ, Bangalore S, Bhatt DL, Ge J, Hermiller J, Makkar RR, Neumann FJ, Saito S, et al. 3- or 1-month DAPT in patients at high bleeding risk undergoing everolimus-eluting stent implantation. JACC Cardiovasc Interv 2021;14(17):1870–1883. The findings of the study suggest that DAPT for either 1 or 3 months is just as effective as 6 or 12 months of DAPT in preventing ischemic outcomes in HBR patients undergoing PCI. Furthermore, the shorter duration of DAPT may be linked to a reduced risk of major bleeding and stent thrombosis. • Mehran R, Cao D, Angiolillo DJ, Bangalore S, Bhatt DL, Ge J, Hermiller J, Makkar RR, Neumann FJ, Saito S, et al. 3- or 1-month DAPT in patients at high bleeding risk undergoing everolimus-eluting stent implantation. JACC Cardiovasc Interv 2021;14(17):1870–1883. The findings of the study suggest that DAPT for either 1 or 3 months is just as effective as 6 or 12 months of DAPT in preventing ischemic outcomes in HBR patients undergoing PCI. Furthermore, the shorter duration of DAPT may be linked to a reduced risk of major bleeding and stent thrombosis.

Zurück zum Zitat •• Escaned J, Cao D, Baber U, Nicolas J, Sartori S, Zhang Z, Dangas G, Angiolillo DJ, Briguori C, Cohen DJ, et al. Ticagrelor monotherapy in patients at high bleeding risk undergoing percutaneous coronary intervention: TWILIGHT-HBR. Eur Heart J 2021;42(45):4624–4634. The study observed that among HBR patients who underwent PCI and completed a 3-month course of DAPT without major adverse events, discontinuing aspirin and transitioning to ticagrelor monotherapy resulted in a significant reduction in bleeding incidents. •• Escaned J, Cao D, Baber U, Nicolas J, Sartori S, Zhang Z, Dangas G, Angiolillo DJ, Briguori C, Cohen DJ, et al. Ticagrelor monotherapy in patients at high bleeding risk undergoing percutaneous coronary intervention: TWILIGHT-HBR. Eur Heart J 2021;42(45):4624–4634. The study observed that among HBR patients who underwent PCI and completed a 3-month course of DAPT without major adverse events, discontinuing aspirin and transitioning to ticagrelor monotherapy resulted in a significant reduction in bleeding incidents.

Zurück zum Zitat Watanabe H, Morimoto T, Natsuaki M, Yamamoto K, Obayashi Y, Ogita M, Suwa S, Isawa T, Domei T, Yamaji K, et al. Comparison of clopidogrel monotherapy after 1 to 2 months of dual antiplatelet therapy with 12 months of dual antiplatelet therapy in patients with acute coronary syndrome: the STOPDAPT-2 ACS randomized clinical trial. JAMA Cardiol. 2022;7(4):407–17.PubMedPubMedCentralCrossRef Watanabe H, Morimoto T, Natsuaki M, Yamamoto K, Obayashi Y, Ogita M, Suwa S, Isawa T, Domei T, Yamaji K, et al. Comparison of clopidogrel monotherapy after 1 to 2 months of dual antiplatelet therapy with 12 months of dual antiplatelet therapy in patients with acute coronary syndrome: the STOPDAPT-2 ACS randomized clinical trial. JAMA Cardiol. 2022;7(4):407–17.PubMedPubMedCentralCrossRef

Zurück zum Zitat Grosser T, Fries S, Lawson JA, Kapoor SC, Grant GR, FitzGerald GA. Drug resistance and pseudoresistance: an unintended consequence of enteric coating aspirin. Circulation. 2013;127(3):377–85.CrossRef Grosser T, Fries S, Lawson JA, Kapoor SC, Grant GR, FitzGerald GA. Drug resistance and pseudoresistance: an unintended consequence of enteric coating aspirin. Circulation. 2013;127(3):377–85.CrossRef

Zurück zum Zitat Abd-El-Aziz AS, Benaaisha MR, Abdelghani AA, Bissessur R, Abdel-Rahman LH, Fayez AM, El-Ezz DA. Aspirin-based organoiron dendrimers as promising anti-inflammatory, anticancer, and antimicrobial drugs. Biomolecules 2021;11(11). Abd-El-Aziz AS, Benaaisha MR, Abdelghani AA, Bissessur R, Abdel-Rahman LH, Fayez AM, El-Ezz DA. Aspirin-based organoiron dendrimers as promising anti-inflammatory, anticancer, and antimicrobial drugs. Biomolecules 2021;11(11).

Zurück zum Zitat Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119–77.CrossRef Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119–77.CrossRef

Zurück zum Zitat Han Y, Liao Z, Li Y, Zhao X, Ma S, Bao D, Qiu M, Deng J, Wang J, Qu P, et al. Magnetically controlled capsule endoscopy for assessment of antiplatelet therapy-induced gastrointestinal injury. J Am Coll Cardiol. 2022;79(2):116–28.PubMedCrossRef Han Y, Liao Z, Li Y, Zhao X, Ma S, Bao D, Qiu M, Deng J, Wang J, Qu P, et al. Magnetically controlled capsule endoscopy for assessment of antiplatelet therapy-induced gastrointestinal injury. J Am Coll Cardiol. 2022;79(2):116–28.PubMedCrossRef

Zurück zum Zitat Hahn JY, Song YB, Oh JH, Chun WJ, Park YH, Jang WJ, Im ES, Jeong JO, Cho BR, Oh SK, et al. Effect of P2Y12 inhibitor monotherapy vs dual antiplatelet therapy on cardiovascular events in patients undergoing percutaneous coronary intervention: the SMART-CHOICE randomized clinical trial. JAMA. 2019;321(24):2428–37.PubMedPubMedCentralCrossRef Hahn JY, Song YB, Oh JH, Chun WJ, Park YH, Jang WJ, Im ES, Jeong JO, Cho BR, Oh SK, et al. Effect of P2Y12 inhibitor monotherapy vs dual antiplatelet therapy on cardiovascular events in patients undergoing percutaneous coronary intervention: the SMART-CHOICE randomized clinical trial. JAMA. 2019;321(24):2428–37.PubMedPubMedCentralCrossRef

Zurück zum Zitat Kang J, Park KW, Lee H, Hwang D, Yang HM, Rha SW, Bae JW, Lee NH, Hur SH, Han JK, et al. Aspirin versus clopidogrel for long-term maintenance monotherapy after percutaneous coronary intervention: the HOST-EXAM extended study. Circulation. 2023;147(2):108–17.PubMedCrossRef Kang J, Park KW, Lee H, Hwang D, Yang HM, Rha SW, Bae JW, Lee NH, Hur SH, Han JK, et al. Aspirin versus clopidogrel for long-term maintenance monotherapy after percutaneous coronary intervention: the HOST-EXAM extended study. Circulation. 2023;147(2):108–17.PubMedCrossRef

Zurück zum Zitat Koo BK, Kang J, Park KW, Rhee TM, Yang HM, Won KB, Rha SW, Bae JW, Lee NH, Hur SH, et al. Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial. Lancet. 2021;397(10293):2487–96.PubMedCrossRef Koo BK, Kang J, Park KW, Rhee TM, Yang HM, Won KB, Rha SW, Bae JW, Lee NH, Hur SH, et al. Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial. Lancet. 2021;397(10293):2487–96.PubMedCrossRef

Zurück zum Zitat Parodi G, Valenti R, Bellandi B, Migliorini A, Marcucci R, Comito V, Carrabba N, Santini A, Gensini GF, Abbate R, et al. Comparison of prasugrel and ticagrelor loading doses in ST-segment elevation myocardial infarction patients: RAPID (Rapid Activity of Platelet Inhibitor Drugs) primary PCI study. J Am Coll Cardiol. 2013;61(15):1601–6.PubMedCrossRef Parodi G, Valenti R, Bellandi B, Migliorini A, Marcucci R, Comito V, Carrabba N, Santini A, Gensini GF, Abbate R, et al. Comparison of prasugrel and ticagrelor loading doses in ST-segment elevation myocardial infarction patients: RAPID (Rapid Activity of Platelet Inhibitor Drugs) primary PCI study. J Am Coll Cardiol. 2013;61(15):1601–6.PubMedCrossRef

Zurück zum Zitat Zhao X, Ai G, Qiu M, Wang X, Zhang L, Yang X, Liu Y, Xu P, Zhang J, Gu C, et al. Efficacy of clopidogrel and ticagrelor under NT-proBNP in hospitalized ST-elevation acute coronary syndrome patients on percutaneous coronary intervention: CCC-ACS Project Analysis. Int J Cardiol. 2020;310:1–8.PubMedCrossRef Zhao X, Ai G, Qiu M, Wang X, Zhang L, Yang X, Liu Y, Xu P, Zhang J, Gu C, et al. Efficacy of clopidogrel and ticagrelor under NT-proBNP in hospitalized ST-elevation acute coronary syndrome patients on percutaneous coronary intervention: CCC-ACS Project Analysis. Int J Cardiol. 2020;310:1–8.PubMedCrossRef

Zurück zum Zitat Schulz S, Richardt G, Laugwitz KL, Morath T, Neudecker J, Hoppmann P, Mehran R, Gershlick AH, Tolg R, Anette Fiedler K, et al. Prasugrel plus bivalirudin vs. clopidogrel plus heparin in patients with ST-segment elevation myocardial infarction. Eur Heart J 2014;35(34):2285–2294. Schulz S, Richardt G, Laugwitz KL, Morath T, Neudecker J, Hoppmann P, Mehran R, Gershlick AH, Tolg R, Anette Fiedler K, et al. Prasugrel plus bivalirudin vs. clopidogrel plus heparin in patients with ST-segment elevation myocardial infarction. Eur Heart J 2014;35(34):2285–2294.

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Zurück zum Zitat Chatzantonis G, Chatzantonis G, Findeisen H, Paul M, Samol A, Bisdas T, Fischer D. Real-world analysis of a Biolimus A9 polymer-free drug-coated stent with very short dual antiplatelet therapy in patients at high bleeding risk. Herz. 2021;46(3):242–9.PubMedCrossRef Chatzantonis G, Chatzantonis G, Findeisen H, Paul M, Samol A, Bisdas T, Fischer D. Real-world analysis of a Biolimus A9 polymer-free drug-coated stent with very short dual antiplatelet therapy in patients at high bleeding risk. Herz. 2021;46(3):242–9.PubMedCrossRef

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Zurück zum Zitat Rout A, Sharma A, Ikram S, Garg A. Short-term dual antiplatelet therapy for 1–3 months after percutaneous coronary intervention using drug eluting stents: a systematic review and meta-analysis of randomized clinical trials. Catheter Cardiovasc Interv. 2022. Rout A, Sharma A, Ikram S, Garg A. Short-term dual antiplatelet therapy for 1–3 months after percutaneous coronary intervention using drug eluting stents: a systematic review and meta-analysis of randomized clinical trials. Catheter Cardiovasc Interv. 2022.

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Zurück zum Zitat Fearon WF, Zimmermann FM, De Bruyne B, Piroth Z, van Straten AHM, Szekely L, Davidavičius G, Kalinauskas G, Mansour S, Kharbanda R, et al. Fractional flow reserve-guided PCI as compared with coronary bypass surgery. N Engl J Med. 2022;386(2):128–37.PubMedCrossRef Fearon WF, Zimmermann FM, De Bruyne B, Piroth Z, van Straten AHM, Szekely L, Davidavičius G, Kalinauskas G, Mansour S, Kharbanda R, et al. Fractional flow reserve-guided PCI as compared with coronary bypass surgery. N Engl J Med. 2022;386(2):128–37.PubMedCrossRef

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