P2Y12 inhibitors – is monotherapy a safe management strategy after percutaneous coronary intervention?

This study investigated the effect of dual antiplatelet therapy (APT) compared to P2Y12 inhibitors on outcomes after a percutaneous coronary intervention (PCI).  

They found that the rate of cardiac events was similar in patients treated with P2Y12 inhibitors or dual APT. 

Coronary artery disease (CAD) is caused by a blockage in the arteries that supply blood to the heart. Percutaneous coronary intervention (PCI) is a surgical procedure to treat CAD. It is minimally invasive and involves using a stent. A stent is a medical device that safely removes a blockage and keeps the blood vessel open. After PCI, patients usually take drugs to prevent more blockages. This is called antiplatelet therapy (APT). The aim of APT is to prevent major adverse cardiac events (MACE). These include heart attack, stroke, and death. 

APT usually involves taking aspirin and a P2Y12 inhibitor drug (P2Y12i) such as clopidogrel (Plavix). This is called dual APT. It is unclear how long a patient should remain on dual APT. Some studies suggest that monotherapy (MT) with P2Y12i may be effective. It is unclear if P2Y12i MT is as effective as dual APT.

This study included 2912 patients undergoing PCI. All patients were treated with dual APT for 3 months. Then patients were randomly assigned to P2Y12i MT or dual APT for 12 months. The rates of MACE were compared at the end of the study. 

The rates of MACE were 2.9% in the MT group and 2.5% in the dual APT group. The rates of death were also similar in both groups (1.4% vs. 1.2%, MT vs. dual APT). Similar rates of heart attack and stroke were observed in both groups. The risk of bleeding was reduced by 42% in P2Y12i MT patients. 

The authors concluded that P2Y12 inhibitors and dual APT resulted in similar outcomes after PCI.

The statistics used to analyze these results were not as strict as might be expected of this kind of trial. As a result, it can be difficult to detect differences between treatments. More investigation is needed to confirm these findings. 

If you have any concerns regarding CAD treatment, please consult with your doctor.