Table 3. Selected recent trials on antiplatelet therapy in patients undergoing percutaneous coronary intervention.
| Study | Year | PMID | Design | Setting | Focus | Main findings |
|---|---|---|---|---|---|---|
| AFIRE | 2019 | 31475793 | RCT | AF in stable CAD | Rivaroxaban vs. rivaroxaban plus OAPT | Rivaroxaban alone is safer and more effective than combination therapy |
| ANTARCTIC | 2016 | 27581531 | RCT | ACS in patients ≥75 years | Prasugrel 5 mg vs. dose/drug adjustment based on PFT on top of aspirin | Default DAPT with prasugrel 5 mg appeared similarly safe and effective to dose/drug adjustment (yielding uptake of prasugrel 10 mg in 4% and clopidogrel in 39%) |
| APPRAISE-2 | 2011 | 21780946 | RCT | ACS | Apixaban vs. placebo on top of DAPT | Apixaban lead to an increase in bleedings without any significant reduction in thrombotic events |
| AUGUSTUS | 2019 | 30883055 | RCT | AF in ACS or PCI | Apixban vs. warfarin vs. aspirin vs. placebo on top of a P2Y12 inhibitor | Combination of apixaban and a P2Y12 inhibitor is safer and as effective than antithrombotic regimens including warfarin or aspirin |
| Claessens et al. | 2019 | 31479209 | RCT | Primary PCI | CYP2C19 genotype-guided selection of P2Y12 inhibitor vs. ticagrelor or prasugrel | CYP2C19 genotype-guided selection of P2Y12 inhibitor is as effective but safer than a default DAPT strategy including ticagrelor or prasugrel |
| COMPASS | 2018 | 29132879 | RCT | Stable CAD | Rivaroxaban plus aspirin vs. rivaroxaban alone vs. aspirin alone | Combined therapy with rivaroxaban and aspirin reduced death and thrombotic events albeit at an increased risk of bleeding in comparison to other strategies |
| DAPT-STEMI | 2018 | 30279197 | RCT | Primary PCI | Discontinuation of P2Y12 inhibitor after 6 months vs. continuation for additional 6 months | Discontinuation of P2Y12 inhibitor after 6 uneventful months following primary PCI was non-inferior to a 12-month DAPT regimen |
| ENTRUST-AF PCI | 2019 | 31492505 | RCT | AF in PCI | Edoxaban vs. warfarin on top of DAPT | Edoxaban proved non-inferior for safety and efficacy endpoint to warfarin |
| Gargiulo et al. | 2016 | 27811064 | PMA | PCI | Short-term vs. long-term DAPT | Short-term DAPT was safer and as effective as long-term DAPT, with the exception of a higher rate of stent thrombosis in diabetics |
| GEMINI-ACS | 2017 | 28325638 | RCT | ACS | Rivaroxaban vs. aspirin on top of P2Y12 inhibitor | Rivaroxaban was as safe as aspirin |
| Gibson et al. | 2016 | 27959713 | RCT | AF in PCI | Low-dose rivaroxaban plus P2Y12 inhibitor vs. very low-dose rivaroxaban plus DAPT vs. warfarin plus DAPT | Low-dose rivaroxaban plus P2Y12 inhibitor and very low-dose rivaroxaban plus DAPT were safer than warfarin plus DAPT |
| GLOBAL LEADERS | 2018 | 30166073 | RCT | PCI | DAPT for 1 month followed by ticagrelor alone for 23 months vs. DAPT for 12 months followed by aspirin for 12 months | DAPT for 1 month followed by ticagrelor alone for 23 months was not superior to a standard DAPT regimen for 12 months followed by aspirin monotherapy |
| ISAR-REACT 5 | 2019 | 31475799 | RCT | ACS | Prasugrel vs. ticagrelor on top of aspirin | Prasugrel proved as safe but more effective than ticagrelor |
| PRECISE-DAPT | 2017 | 28290994 | CPS | PCI | Predictive accuracy of score encompassing age, CC, Hb, WBC, and prior bleeding | The PRECISE-DAPT score had discrimination of 0.73 in the derivation set and 0.66-0.70 in validation sets, with higher score predicting greater benefits from long-term DAPT |
| RE-DUAL PCI | 2017 | 28844193 | RCT | AF in PCI | Warfarin plus DAPT vs. dabigatran plus P2Y12 inhibitor | Dabigatran plus P2Y12 inhibitor was safer and as effective as warfarin plus DAPT |
| SMART-CHOICE | 2019 | 31237645 | RCT | PCI | Short-term vs. standard DAPT | Short-term DAPT proved non-inferior to standard DAPT |
| SMART-DATE | 2018 | 29544699 | RCT | ACS | Short-term vs. standard DAPT | Short-term DAPT proved associated with more myocardial infarctions than standard DAPT |
| STOPDAPT-2 | 2019 | 31237644 | RCT | PCI | 1-month DAPT followed by clopidogrel alone vs. 12-month DAPT | 1-month DAPT followed by clopidogrel alone was safer and as effective than 12-month DAPT |
| THEMIS-PCI | 2019 | 31484629 | RCT | Stable CAD and DM | Ticagrelor vs. placebo in stable diabetics with prior PCI at low bleeding risk | Ticagrelor reduced thrombotic events but increased bleedings in comparison to placebo |
| TROPICAL-ACS | 2017 | 28855078 | RCT | ACS | 12-month DAPT with prasugrel vs. de-escalation 14 days after discharge according to PFT | De-escalation according to PFT was as safe and as effective as standard DAPT |
| Yin et al. | 2019 | 31253632 | NMA | PCI | Short- vs. standard vs. long-term DAPT | Short-term DAPT was safer than both standard or long-term DAPT, especially when using new-generation stents |
ACS, acute coronary syndrome; AF, atrial fibrillation; CAD, coronary artery disease; CC, creatinine clearance; CPS, clinical prediction score; DAPT, dual antiplatelet therapy; DM, diabetes mellitus; Hb, hemoglobin; NMA, network meta-analysis; OAPT, oral antiplatelet therapy; PCI, percutaneous coronary intervention; PFT, platelet function testing; PMA, pairwise meta-analysis; RCT, randomized clinical trial; WBC, white blood cell count.