P2Y Inhibitor Monotherapy in Patients Undergoing Percutaneous Coronary Intervention

Overview

Journal Nat Rev Cardiol

Specialty Cardiology & Vascular Diseases

Date 2022 Jun 13

PMID 35697777

Authors

Davide Capodanno

Usman Baber

Deepak L Bhatt

Jean-Philippe Collet

George Dangas

Francesco Franchi

C Michael Gibson

Hyeon-Cheol Gwon

Adnan Kastrati

Takeshi Kimura

Pedro A Lemos

Renato D Lopes

Roxana Mehran

Michelle L ODonoghue

Sunil V Rao

Fabiana Rollini

Patrick W Serruys

Philippe G Steg

Robert F Storey

Marco Valgimigli

Pascal Vranckx

Hirotoshi Watanabe

Stephan Windecker

Dominick J Angiolillo

Affiliations

Soon will be listed here.

Abstract

For 20 years, dual antiplatelet therapy (DAPT), consisting of the combination of aspirin and a platelet P2Y 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 P2Y 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 P2Y inhibitor monotherapy after PCI. Generalizing the results of studies of P2Y 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 P2Y inhibitor monotherapy after PCI, including supporting pharmacodynamic and clinical evidence, practical recommendations and future directions.

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