Three studies bring you up-to-date on the optimal length of dual antiplatelet therapy; the role (or lack thereof) for platelet transfusion for serious GI bleeding in patients taking antiplatelet medication; and the efficacy of factor Xa reversal agent.
Optimal Duration of Dual Antiplatelet Therapy?
A recent review of 11 randomized controlled trials including 33,051 patients (most of whom had received drug-eluting stents [DES]) sought to clarify questions about the optimal duration of dual antiplatelet therapy (DAPT) after implantation of DES or myocardial infarction (MI). The review included 33,051 patients (most of whom had received DES) and compared use of DAPT for 18 to 48 months vs use for 6 to 12 months.
Longer-term DAPT was associated with no difference in incidence of all-cause death but was associated with increased major hemorrhage, decreased MI, and decreased stent thrombosis. Post hoc analyses provided weak evidence of increased mortality with prolonged DAPT. Use of DAPT >1 year after MI reduced the composite risk of cardiovascular death, MI, or stroke but increased major bleeding.
The investigators concluded that prolonged DAPT after implantation of newer-generation DES entails a tradeoff between reductions in stent thrombosis and MI and increases in major hemorrhage. In patients whose coronary thrombotic risk was defined by a prior MI rather than by DES implantation, the primary analysis provides moderately strong evidence of reduced cardiovascular events at the expense of increased bleeding.
Bittl JA, Baber U, Bradley SM, et al. Duration of dual antiplatelet therapy: a systematic review for the 2016 AHA/ACC guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease. J Am Coll Cardiol. 2016;68:1116-1139.
Platelet Transfusion for GI Bleeding?
Antiplatelet drugs, such as aspirin and thienopyridines, increase the risk for gastrointestinal bleeding (GIB). Because these drugs act for the entire life of the platelet, it is reasonable to assume that platelet transfusion might be helpful in cases of severe bleeding.
To investigate this approach, investigators retrospectively compared outcomes between recipients and non-recipients of platelet transfusion among patients who were taking antiplatelet drugs and admitted for GIB. They identified 204 patients who received platelet transfusions, who were matched by age, sex, and GIB location to 204 patients not receiving transfusion