Short-term dual antiplatelet therapy after coronary artery stenting

Tarasov R.S.; Bokhan N.S.; Ganyukov V.I.

doi:https://doi.org/10.17116/kardio202114061455

Close metadata

Recommended articles:

Intravascular physiology and imaging in determining the indications for revascularization in patients with intermediate coronary stenosis. Russian Journal of Cardiology and Cardiovascular Surgery. 2025;(3):255-260

Myocardial injury following elective percutaneous coronary interventions: prevalence, risk factors and prognostic significance. Russian Journal of Cardiology and Cardiovascular Surgery. 2025;(3):261-268

Outcomes of endovascular treatment for myocardial infarction and different phenotypes of coronary microvascular obstruction syndrome (slow-flow/no-reflow). Russian Journal of Cardiology and Cardiovascular Surgery. 2026;(2):49-57

Manifestation of stenosis of the anterior interventricular branch of the left coronary artery: the Hiss beam legs blockade. Russian Journal of Preventive Medicine. 2025;(5):96-102

Analytical review of the pathophysiological mechanisms of ischemia-reperfusion syndrome development in PCI. Russian Journal of Anesthesiology and Reanimatology. 2025;(5):88-97

Intranasal stents in endoscopic paranasal sinus surgery: a review of efficacy and safety. Russian Bulletin of Otorhinolaryngology. 2025;(5):100-107

Abstract:

Percutaneous coronary intervention (PCI) is the most common interventional procedure in the world. Annual number of PCIs in the world was about 5 million by 2019. Coronary stent implantation requires dual antiplatelet therapy (DAPT). The main objective of therapy is prevention of stent thrombosis as a life-threatening complication with a poor prognosis. Six-month period of DAPT is standard for stable coronary artery disease, 12-month therapy — for acute coronary syndrome. Modern guidelines allow reducing DAPT time up to 3 or even 1 month in patients with high hemorrhagic risks. However, these recommendations are characterized by low evidence level. There are patients who underwent PCI with stenting and require early cancellation of DAPT within 30 days (indications for emergency surgery, hemorrhagic complications). In this regard, analysis of safety of short-term DAPT in certain clinical situations including PCI with various coronary stents is of particular relevance. In this manuscript, the authors discuss modern evidence base on reduced DAPT period after PCI, analyze the studies devoted to different coronary stents and risk of thrombosis for certain duration of DAPT. Moreover, evidence base for stents with bioengineering coating and the role of optical coherence tomography in assessing the coronary stent endothelialization are emphasized.

Keywords:

short-term dual antiplatelet therapy

withdrawal of antiplatelet agents after PCI

hemorrhagic risks

percutaneous coronary intervention

bioengineered coronary stents

drug-eluting stents

Authors:

Tarasov R.S.

Research Institute for Complex Issues of Cardiovascular Diseases

Bokhan N.S.

Research Institute for Complex Issues of Cardiovascular Diseases

Ganyukov V.I.

Research Institute for Complex Issues of Cardiovascular Diseases

Received:

31.12.2020

Accepted:

20.01.2021

Close metadata

References:

Gruntzig A. Transluminal dilatation of coronary-artery stenosis. Lancet. 1978;1:263.
Iqbal J, Gunn J, Serruys PW. Coronary stents: historical development, current status and future directions. British Medical Bulletin. 2013;106:193-211. https://doi.org/10.1093/bmb/ldt009
Gerber Y, Rihal C, Sundt TR, Killian J, Weston S, Therneau T. Coronary revascularization in the community. A population-based study, 1990 to 2004. J Am Coll Cardiol. 2007;50:1223-1229.
MedMarket Diligence. Global dynamics of surgical and interventional cardiovascular procedures, 2015-2022 [report #C500].
D’Ascenzo F, Bollati M, Clementi F, et al. Incidence and predictors of coronary stent thrombosis: evidence from an international collaborative meta-analysis including 30 studies, 221,066 patients, and 4276 thromboses. Int J Cardiol. 2013;167(2):575-584.
Torrado J, Buckley L, Durán A, et al. Restenosis, stent thrombosis, and bleeding complications: navigating between Scylla and Charybdis. J Am Coll Cardiol. 2018;71:1676-1695.
Généreux P, Rutledge DR, Palmerini L, et al. Stent thrombosis and dual antiplatelet therapy interruption with everolimuseluting stents: insights from the Xience V Coronary Stent System trials. Circ Cardiovasc Interv. 2015;8(5):e001362. https://doi.org/10.1161/CIRCINTERVENTIONS.114.001362
Giustino G, Baber U, Sartori S, et al. Duration of dual antiplatelet therapy after drug-eluting stent implantation: A systematic review and meta-analysis of randomized controlled trials. J Am Coll Cardiol. 2015;65:13:1298-1310. https://doi.org/10.1016/j.jacc.2015.01.039
Gori T, Polimeni A, Indolfi C, et al. Predictors of stent thrombosis and their implications for clinical practice. Nat Rev Cardiol. 2019;16(4):243-256. https://doi.org/10.1038/s41569-018-0118-5
Ganyukov VI, Bokhan NS, Tarasov RS, et al. Short-term therapy with clopidogrel after bioengineered stent implantation as a component of staged treatment of patients with multifocal atherosclerosis. Medicine in Kuzbass. 2012;4:4-9. (In Russ.).
Valgimigli M, Bueno H, Byrne R, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Russian Journal of Cardiology. 2018;8:113-163. (In Russ.). https://doi.org/10.15829/1560-4071-2018-8-113-163
Kim BK, Hong MK, Shin DH, et al. A new strategy for discontinuation of dual antiplatelet therapy: the RESET Trial (REal Safety and Efficacy of 3-month dual antiplatelet Therapy following Endeavor zotarolimus-eluting stent implantation). J Am Coll Cardiol. 2012;60:1340-1348.
Kristensen SD, Knuuti J, Saraste A, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014;35:2383-2431.
Siller-Matula JM, Petre A, Delle-Karth G, et al. Impact of preoperative use of P2Y12 receptor inhibitors on clinical outcomes in cardiac and non-cardiac surgery: A systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care. 2017;6(8):753-770. https://doi.org/10.1177/2048872615585516
Berger PB, Kleiman NS, Pencina MJ, et al. Frequency of major noncardiac surgery and subsequent adverse events in the year after drug-eluting stent placement results from the EVENT (Evaluation of Drug-Eluting Stents and Ischemic Events) Registry. JACC Cardiovasc Interv. 2010;3:920-927.
Levine GN, Bates ER, Blankenship JC, et al. American College of Cardiology Foundation, American Heart Association Task Force on Practice Guidelines, Society for Cardiovascular Angiography and Interventions. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011;58:44-122.
Mehran R, Baber U, Steg PG, et al. Cessation of dual antiplatelet treatment and cardiac events after percutaneous coronary intervention (PARIS): 2 year results from a prospective observational study. Lancet. 2013;382:1714-1722.
Egholm G, Kristensen SD, Thim T, et al. Risk associated with surgery within 12 months after coronary drug-eluting stent implantation. J Am Coll Cardiol. 2016;68:2622-2632.
Dimitrova G, Tulman DB, Bergese SD. Perioperative management of antiplatelet therapy in patients with drug-eluting stents. HSR Proc Intensive Care Cardiovasc Anesth. 2012;4:153-167.
Holcomb CN, Graham LA, Richman JS,et al. The incremental risk of coronary stents on postoperative adverse events: A matched cohort study. Ann Surg. 2016;263:924-930.
Gherli R, Mariscalco G, Dalen M, et al. Safety of preoperative use of ticagrelor with or without aspirin compared with aspirin alone in patients with acute coronary syndromes undergoing coronary artery bypass grafting. JAMA Cardiol. 2016;1:921-928.
De Servi S, Morici N, Boschetti E, et al. Bridge therapy or standard treatment for urgent surgery after coronary stent implantation: analysis of 314 patients. Vascul Pharmacol. 2016;80:85-90.
Hawn MT, Graham LA, Richman JS, et al. Risk of major adverse cardiac events following noncardiac surgery in patients with coronary stents. JAMA. 2013;310:1462-1472.
Banerjee S, Angiolillo D, Boden W, et al. Use of Antiplatelet Therapy/DAPT for Post-PCI Patients Undergoing Noncardiac Surgery. J Am Coll Cardiol. 2017;69(14):1861-1870. https://doi.org/10.1016/j.jacc.2017.02.012
Knuuti J. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Russian Journal of Cardiology. 2020;25(2):3757. (In Russ.). https://doi.org/10.15829/1560-4071-2020-2-3757
Aoki J, Serruys PW, van Beusekom H. Endothelial progenitor cell capture by stents coated with antibody against CD34: the HEALING-FIM (Healthy Endothelial Accelerated Lining Inhibits Neointimal Growth-First In Man) Registry. J Am Coll Cardiol. 2005;45:1574-1579.
Kaushal S, Amiel GE, Guleserian KJ. Functional smalldiameter neovessels created using endothelial progenitor cells expanded ex vivo. Nat Med. 2001;7:1035-1040.
van Beusekom HMM, Ertas G, Sorop O, et al. The GenousTM Endothelial Progenitor Cell Capture Stent Accelerates Stent Re-endothelialization but Does not Affect Intimal Hyperplasia in Porcine Coronary Arteries. Catheterization and Cardiovascular Interventions. 2012;79:231-242.
Duckers HJ, Silber S, de Winter R, et al. Circulating endothelial progenitor cells predict angiographic and intravascular ultrasound outcome following percutaneous coronary interventions in the HEALING-II trial: evaluation of an endothelial progenitor cell capturing stent. EuroIntervention. 2007;3:67-75.
Duckers HJ, Soullie ÂT, den Heijer P, et al. Accelerated vascular repair following percutaneous coronary intervention by capture of endothelial progenitor cells promotes regression of neointimal growth at long term follow-up: final results of the Healing II trial using an endothelial progenitor cell capturing stent (Genous R stent). EuroIntervention. 2007;3:350-358.
Klomp M, Beijk MA, Damman P, et al. Three-year clinical follow-up of an unselected patient population treated with the genous endothelial progenitor cell capturing stent. J Interv Cardiol. 2011;24:442-449. https://doi.org/10.1111/j.1540-8183.2011.00665.x
Klomp M, Beijk MA, Varma C, et al. 1-year outcome of TRIAS HR (TRI-stent adjudication study-high risk of restenosis) a multicenter, randomized trial comparing genous endothelial progenitor cell capturing stents with drug-eluting stents. JACC Cardiovasc Interv. 2011;4:896-904. https://doi.org/10.1016/j.jcin.2011.05.011
Den Dekker WK, Houtgraaf JH, Onuma Y, et al. Final results of the HEALING IIB trial to evaluate a bio-engineered CD34 antibody coated stent (Genous Stent) designed to promote vascular healing by capture of circulating endothelial progenitor cells in CAD patients. Atherosclerosis. 2011;219:245-252. https://doi.org/10.1016/j.atherosclerosis.2011.06.032
Co M, Tay E, Lee CH, Poh KK, Low A, Lim J. Use of endothelial progenitor cell capture stent (Genous Bio-Engineered R Stent) during primary percutaneous coronary intervention in acute myocardial infarction: intermediate- to long-term clinical follow-up. Am Heart J. 2008;155:128-132. https://doi.org/10.1016/j.ahj.2007.08.031
Lee YP, Tay E, Lee CH, et al. Endothelial progenitor cell capture stent implantation in patients with ST-segment elevation acute myocardial infarction: one-year follow-up. EuroIntervention. 2010;5:698-702.
Giurgea G-A, Heuberger A, Babayev J, et al. Nine-year clinical follow-up of patients with ST-segment elevation myocardial infarction with Genous or TAXUS Liberté stents. PLoS One. 2018; 13(8):e0201416. https://doi.org/10.1371/journal.pone.0201416
Saito S, Krucoff MW, Nakamura S, et al. Japan-United States of America Harmonized Assessment by Randomized Multicentre Study of OrbusNEich’s Combo StEnt (Japan-USA HARMONEE) study: primary results of the pivotal registration study of combined endothelial progenitor cell capture and drug-eluting stent in patients with ischaemic coronary disease and non-ST-elevation acute coronary syndrome. Eur Heart J. 2018;39(26):2460-2468. https://doi.org/10.1093/eurheartj/ehy275
Kalkman DN, Kerkmeijer LS, Woudstra P. Three-year clinical outcomes after dual therapy COMBO stent placement: Insights from the REMEDEE registry. Catheter Cardiovasc Interv. 2019;94:342-347. https://doi.org/10.1002/ccd.28047
Sangiorgi GM, Morice M, Bramucci E, et al. Evaluating the safety of very short-term (10 days) dual antiplatelet therapy after Genous bio-engineered R stent implantation: the multicentre pilot GENOUS trial. EuroIntervention. 2011;7(7):813-819. https://doi.org/10.4244/EIJV7I7A128
Guagliumi G, Sirbu V. Optical coherence tomography: high-resolution intravascular imaging to evaluate vascular healing after coronary stenting. Catheter Cardiovasc Interv. 2008;72(2):237-247. https://doi.org/10.1002/ccd.21606
Koppara T, Tada T, Xhepa E, et al. Randomized comparison of vascular response to biodegradable polymer sirolimus eluting and permanent polymer everolimus eluting stents: An optical coherence tomography study. Int J Cardiol. 2018;258:42-49. https://doi.org/10.1016/j.ijcard.2018.01.011
Onuma Y, Thuesen L, van Geuns R, et al. Randomized study to assess the effect of thrombus aspiration on flow area in patients with ST-elevation myocardial infarction: An optical frequency domain imaging study-TROFI trial. Eur Heart J. 2013;34(14):1050-1060.
Ibragimov RU, Badoyan AG, Khelimskiy DA, Krestyaninov OV, Pokushalov EA, Romanov AB. Results of stenting the left main lesions in patients with stable coronary artery disease using biodegradable polymer and permanent polymer stents. Circulation Pathology and Cardiac Surgery. 2018;22(3):59-68. (In Russ.). https://doi.org/10.21688/1681-3472-2018-3-49-55