Out for Aspirin in Secondary Prevention?

ESC 2022

Results of the Panther study presented during the hotline session of the ESC Congress¹ suggest that patients with coronary artery disease should take a P2Y12 inhibitor instead of aspirin to prevent coronary events.

“The results of our analysis, which included all available evidence on this question from randomized trials, call into question the role of aspirin in the prevention of cardiovascular events and a direction towards the use of P2Y12 inhibitor monotherapy for long-term antithrombotic The paradigm should inspire change. “Management of coronary artery disease,” Prof. Dr. Marco Valgimigli of the Cardiocentro Ticino Foundation in Lugano, Switzerland presented the results of the study.

Long-term inhibition of platelet aggregation is currently the recommended long-term treatment for patients with established coronary artery disease, whereas the increased risk of bleeding in primary prevention outweighs the benefits of prophylactic aspirin intake.² Patients following acute coronary syndrome or elective percutaneous intervention initially receiving dual antiplatelet therapy with aspirin and a P2Y12 inhibitor (DAPT), which is reduced to aspirin monotherapy after a certain period depending on the patient’s risk profile . Several studies have looked at what happens when aspirin is discontinued rather than a P2Y12 inhibitor. More than 20 years ago, the CAPRIE study showed a modest but significantly more pronounced reduction in cardiovascular events with the P2Y12 inhibitor clopidogrel than with aspirin.³ Overall, however, the data were not conclusive.