Атеротромбоз (Jan 2024)
Which patients with myocardial infarction can be prescribed only P2Y12 inhibitor and stop using aspirin?
Abstract
The review discusses current approaches to the composition and duration of antiplatelet therapy in patients with acute coronary syndromes. The “standard” therapy has been known to include aspirin and active platelet P2Y12 receptor blocker for 12 months. This approach effectively prevents the development of thrombotic complications, but is predictably associated with an increased risk of bleeding. Understanding the issue of bleeding contributed to the arrangement of studies specifically aimed at assessing the efficacy and safety of early (after 1–3 months) discontinuation of aspirin while maintaining P2Y12 receptor blocker monotherapy. Serial meta-analyses of studies conducted over the past few years have shown typically similar results. Decreased frequency of bleeding and no “comprometation” in terms of thrombotic complications was observed in patients for whom the abbreviated therapy strategy was chosen. Among all P2Y12 platelet receptor blockers, the best evidence base has been collected for ticagrelor. The monotherapy with this drug resulted in not only expected reduction in the number of bleedings, but also in a positive effect on mortality, which risk decreased by almost 15%. Until recently, ticagrelor monotherapy was allowed for patients who were not at high bleeding risk, but today the optimal balance between effectiveness and safety has been also demonstrated in patients at high haemorrhagic risk. Thus, the existing evidence base supports a new alternative strategy to minimize bleeding, which suggests switching to P2Y12 blocker monotherapy in revascularized patients 3–6 months after an acute coronary syndrome (ACS) event. It therefore appears logical to use such approach to individuals without a high risk of ischemic events and in the absence of such during the initial treatment with two antiplatelet agents.
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