ESC 2020 online interview with Professor Dominick Angioliio, Single Antiplatellite Therapy: Insights into Early Use

Given the widespread use of antiplater drugs and their risk of bleeding, it is important to further understand the safety of antiplater drugs, including monoantial and double resistance.
In particular, recent studies have highlighted early single antiplate plate plate treatment in PCI patients, and to explore this issue, we brought in Professor Dominick Angioliio of the University of Florida School of Medicine to answer questions.
question 1: What makes it possible for cardiologists to use a single antiplatet treatment after shortening the course of double antiplatet treatment (DAPT)? Prof Dominick Angioliio: There is no doubt that one of the main mechanisms we can shorten the duration of DAPT is due to better bracket design.
we now have a new generation of drugs to remove stents, not only have good efficacy data, but also have good safety data.
safety data can even show that the risk associated with thrombosis complications is lower than the risk of implanting a bare metal stent, and that the absolute number of risks is generally very low.
, it certainly makes us less aggressive in DAPT duration.
while maintaining efficacy without any signs of increased thrombosis complications.
2: What do you think of recent research showing that the emphasis on the early use of single antiplateted plateplate therapy in PCI patients? Prof Dominick Angioliio: This is definitely an emerging concept in the field of intervention pharmacy, the so-called aspirin-free strategy.
, what does that mean? This means that instead of deactiving P2Y? Inhibitors, which I mentioned more in the last question, maintain aspirin monotherapy, why not consider the other way around? In other words, deactiving aspirin and maintaining P2Y? Inhibitors are treated with a single drug.
now the reason behind this is due to P2Y??? Signal conduction playes a key role in plate plate activation and amplification.
know that they play an important role in preventing relapsed isoemia events in patients treated with stents or patients with acute coronary syndrome.
other hand, we know that, as I mentioned before, we have safer brackets.
so, when you put all this information together, why not consider giving up aspirin and maintaining P2Y? What about the suppression strategy? The current data are very, very encouraging, and they have made it clear that this has become a bleeding reduction strategy, and there is no trade-off in this regard as to the increase in isoemia caused by giving up aspirin.
so it's a new concept.
we're going to hear more and more about this.
would like to see it included in the practical guide, but it is definitely a new option in our arsenal of therapeutic weapons.
Question 3: Which patients are eligible for early switch to single antiplatet treatment? Prof Dominick Angioliio: Like all new strategies, we need to start step by step and try to identify some key groups and apply this approach to those people.
, if we think about what the goal of this strategy is: it's a strategy to reduce bleeding.
can we reduce bleeding complications while maintaining efficacy? So I think it's natural for us to implement this approach in patients with a high risk of bleeding.
's reasonable.
think that once we've determined how convenient we are, we can extend this approach to a broader base audience.
why do we say that? I say this because clinical trials are not designed specifically for patients at high risk of bleeding, but for a wider patient population.
so, like many treatment strategies, we don't automatically change from one to another overnight; we accumulate experience in studying patient populations, and then we slowly expand our adaptive disorders.
, my advice is to consider this as the first method in patients with a high risk of bleeding.
now have new academic research alliance guidelines to define patients at high risk of bleeding.
these can be easily downloaded on friendly apps, and I think these are very simple tools and methods - implementing P2Y in your patients? The method of single-drug treatment of inhibitors.
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