Antiplatelet Monotherapies for Long-Term Secondary Prevention Following Percutaneous Coronary Intervention

Area of Science:

• Cardiology
• Pharmacology
• Interventional Cardiology

Background:

• Dual antiplatelet therapy (DAPT), comprising aspirin and a P2Y12 inhibitor, is the standard for secondary prevention in coronary artery disease (CAD) patients post-percutaneous coronary intervention (PCI).
• Current guidelines recommend DAPT for 6-12 months, but advancements in PCI technology and pharmacology are prompting a re-evaluation of long-term DAPT necessity.

Purpose of the Study:

• To review the rationale behind long-term antiplatelet therapy in CAD patients.
• To discuss the pharmacology of P2Y12 inhibitor monotherapy for long-term use.
• To summarize current evidence comparing different long-term antiplatelet monotherapies post-PCI.

Main Methods:

• Literature review of studies evaluating antiplatelet therapies in CAD patients.
• Analysis of evidence supporting P2Y12 inhibitor monotherapy versus DAPT and aspirin monotherapy.
• Examination of pharmacological properties of antiplatelet agents for long-term administration.

Main Results:

• P2Y12 inhibitor monotherapy, particularly ticagrelor, after a short DAPT course, may reduce bleeding events without compromising ischemic protection compared to standard DAPT.
• Evidence for long-term P2Y12 inhibitor monotherapy beyond the first year post-PCI is growing but less robust than for aspirin monotherapy.
• Aspirin monotherapy remains the predominant strategy for long-term secondary prevention in many CAD patients.

Conclusions:

• P2Y12 inhibitor monotherapy is a viable strategy to reduce bleeding risk in CAD patients post-PCI, with potential for long-term secondary prevention.
• Further robust data are needed to establish the optimal long-term antiplatelet strategy, especially comparing different monotherapy agents beyond the initial post-PCI period.