ESC 2022
The results of the PANTHER study presented during a hotline session of the ESC Congress1 suggest that patients with coronary heart 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 towards the use of P2Y12 inhibitor monotherapy for the long-term antithrombotic.” management of coronary artery disease,” commented Prof. Dr. Marco Valgimigli from 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, while in primary prevention the increased risk of bleeding outweighs the advantages of prophylactic aspirin intake.2 Patients following an acute coronary syndrome or an elective percutaneous intervention initially receive dual antiplatelet therapy with aspirin and a P2Y12 inhibitor (DAPT), which is reduced to aspirin monotherapy following a certain period of time, depending on the patient’s risk profile. Several studies have looked at what happens when the aspirin is stopped instead of the P2Y12 inhibitor. More than 20 years ago, the CAPRIE study showed a slight but significantly more pronounced reduction in cardiovascular events with the P2Y12 inhibitor clopidogrel compared to aspirin.3 Overall, however, the data were not conclusive.
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