Out of aspirin in secondary prevention?

ESC 2022

The results of the PANTHER study were presented during the ESC Conference hotline session¹ 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, question the role of aspirin in the prevention of cardiovascular events and should prompt a paradigm shift toward the use of P2Y12 inhibitor monotherapy for long-acting anticoagulants,” commented Professor Dr. Marco Valgimigli of Cardiocentro Ticino Foundation in Lugano, Switzerland, study results.

Long-term inhibition of platelet aggregation is the recommended long-term treatment for patients with coronary artery disease, while in primary prevention the increased risk of bleeding outweighs the advantages of prophylactic aspirin.² Patients with acute coronary syndrome or elective percutaneous intervention initially receive dual antiplatelet therapy with aspirin and a P2Y12 inhibitor (DAPT), which is reduced to aspirin monotherapy after a certain period of time depending on the patient’s risk profile. Several studies have looked at what happens when aspirin is stopped rather than a P2Y12 inhibitor. Over 20 years ago, the CAPRIE study demonstrated a slight but more significant reduction in cardiovascular events with the P2Y12 inhibitor clopidogrel compared to aspirin.³ In general, however, the data were not conclusive.