17 May 2022
What is the best antithrombotics strategy after PCI? - EuroPCR 2022
Case-based discussions and the very first presentation of data from two meta-analyses combine in an interactive session that aims to help clinicians navigate their way through the use of acute and chronic antithrombotics.
Marco Valgimigli explains, “It’s great that we now have a whole variety of antithrombotic agents and strategies available for use in patients undergoing PCI. However, this choice brings with it the problem of deciding which antithrombotic to use for which patient. Also, which antithrombotic regimen is best in the first 12 months after ACS or PCI and what is the optimal strategy beyond the first year?”
This highly interactive session uses cases to explore the management of patients in the different phases. The discussion was informed by the presentation of never-before-seen data from two network meta-analyses. “What today’s physician is missing is data on the comparative effectiveness of the multiple antithrombotic agents available,” says Marco Valgimigli. “We conducted two network meta-analyses – one in the acute and one in the chronic setting – simulating the comparison of treatment options that have never been investigated in head-to-head studies. These rather unique analyses include data from the earliest studies right up to the present day.”
“What we found from the acute meta-analysis,” says Marco Valgimigli, “is that ticagrelor monotherapy, dual therapy with aspirin plus ticagrelor and triple therapy with aspirin plus rivaroxaban and clopidogrel all reduced mortality compared with aspirin plus clopidogrel. However, the mortality benefits of the combination therapies came at the cost of an increased bleeding risk not seen with ticagrelor monotherapy. In the long-term meta-analysis, aspirin plus clopidogrel and P2Y12-inhibitor monotherapy, especially ticagrelor, were the most effective regimens for reducing the risk of myocardial infarction compared with aspirin alone. However, a combination of aspirin plus rivaroxaban was the most effective treatment option for reducing the risk of stroke.” Similar to what was seen in the acute meta-analysis, combination therapy increased the risk of bleeding in the long-term setting.
“The results will be incredibly important in enabling clinicians to tailor treatment according to individual patient needs,” thinks Professor Valgimigli. The findings will be presented in more detail later in the year at ESC Congress 2022 and are expected to be included in a forthcoming consensus document.
Tuesday’s session gave participants the chance to not only see these results ahead of the rest of the world but also to discuss with peers and opinion leaders just how the data should be interpreted and, crucially, implemented in clinical practice.
