iCVCT 4. DAPT Considerations in Patients Post-PCI Trials
Sunday December 6th: 6:00 – 8:00 pm
Randomized trials, assessing the balance of risk of thrombotic and bleeding events after percutaneous coronary intervention (PCI) are especially relevant for patients at high bleeding risk (HBR). Dual antiplatelet therapy (DAPT), consisting of a P2Y12 inhibitor and aspirin, is foundational treatment after PCI. Randomized trials have shown that DAPT reduces the risk of short- and long-term major adverse cardiovascular events, but also increases the risk of major bleeding. But questions remain. Should future trials focus on the population of patients at HBR? Can duration of DAPT be shortened? What do we do with the PCI patient who has atrial fibrillation? What is the role of single antiplatelet therapy and should it consist of aspirin or a P2Y12 inhibitor?
This session will be co-chaired by Davide Capodanno, Chair of Cardiology at the University of Catania, in Catania, Italy, and Dr. Sunil Rao, Section Chief of Cardiology at the Durham VA Medical Center, and an investigator at The Duke Clinical Research Institute in Durham, NC, USA.
Early generation drug-eluting stents (DES) delayed vascular healing and endothelialisation, and were associated with an increased risk of late and very late stent thrombosis (ST). In this context, clinical practice guidelines recommended at least 12 months of DAPT. However, stent designs have evolved, and pooled data indicates that current generation DES have a lower risk for ST than bare metal stents. In an environment of low risk of thrombosis, the issue of bleeding risk over the long term becomes more important, particularly in patients who meet criteria for HBR such as those requiring oral anticoagulation, patients with cancer, or those with impending non-cardiac surgery.
This session will discuss the state-of-the art of DAPT post-PCI. We will take an in-depth look at how best to define the HBR patient (Dr. Capodanno), including the utility of risk scores (Usman Baber, New York, USA). In 2019, the Academic Research Consortium for HBR (ARC-HBR) proposed a consensus definition of HBR in an effort to standardize the patient population included in HBR trials. The primary goal was to advance the consistency and quality of data collection and reporting. Dr. Capodanno, a member of the ARC-HBR will provide an inside look at the consensus definition, and its context for use in trials including patients who have historically been under-represented in device and drug studies. Dr. Deepak Bhatt (Boston, USA) and Dr. Dominick Angiolillo (Jacksonville, USA) will debate the pros and cons of P2Y12 monotherapy.
The session and the moderated multi-stake holders debate will include additional points of view from industry (Narinder Bhalla, Astrazeneca, USA), and regulatory representatives (Adrian Magee, US FDA), as well as practical insight from our patient trialists.