Dual antiplatelet therapy (DAPT) for 12 months has historically been the standard of care following percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS); however, prolonged DAPT carries a cumulative, time-dependent risk of major bleeding. We aimed to determine whether a short DAPT duration (≤6 months) followed by single antiplatelet therapy reduces bleeding events without compromising ischemic safety compared with standard 12-month DAPT in ACS patients. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) by searching Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), and Cochrane Controlled Register of Trials (CENTRAL) from inception to March 2026 for studies comparing short DAPT (≤6 months) versus standard DAPT (12 months) in adults undergoing PCI with drug-eluting stents for ACS. The co-primary endpoints were major bleeding and major adverse cardiovascular events (MACE), defined as a composite of death, myocardial infarction (MI), and stroke. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a DerSimonian-Laird random-effects model, with pre-specified subgroup analyses according to the type of P2Y12 inhibitor used during the monotherapy phase. Seven RCTs comprising 23,586 patients were included. Compared with standard 12-month DAPT, short DAPT significantly reduced the risk of major bleeding by 40% (HR 0.60, 95% CI 0.49-0.73; p<0.001), without a statistically significant increase in MACE (HR 1.02, 95% CI 0.88-1.17; p=0.79), all-cause mortality (HR 0.96, 95% CI 0.80-1.14; p=0.66), or stroke (HR 0.91, 95% CI 0.70-1.17; p=0.46). Subgroup analysis demonstrated a significant interaction by P2Y12 inhibitor type for MI (p=0.016) and MACE (p=0.033), whereby early transition to clopidogrel monotherapy was associated with an approximately two-fold increase in MI risk, whereas monotherapy with a potent P2Y12 inhibitor (e.g., ticagrelor) preserved ischemic safety without excess events. In conclusion, in patients with ACS undergoing PCI, abbreviated DAPT (≤6 months) optimizes net clinical benefit by substantially reducing major bleeding without increasing overall ischemic or mortality risk; however, this safety is critically dependent on the choice of maintenance antiplatelet agent, with potent P2Y12 inhibitor monotherapy representing a safe strategy and early de-escalation to clopidogrel conferring excess MI risk.

Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is standard following PCI. Ticagrelor is increasingly preferred due to its potent, reversible platelet inhibition. While generally safe, ticagrelor has been associated with conduction abnormalities, including sinus pauses and atrioventricular (AV) block, though clinically significant bradyarrhythmias remain rare. We report a rare case of symptomatic 2:1 Mobitz type II AV block following ticagrelor initiation post-PCI and emphasize the importance of timely recognition to avoid unnecessary pacemaker implantation. We describe a 68-year-old woman presenting with unstable angina. Coronary angiography revealed significant mid-RCA disease, and PCI with a sirolimus-eluting stent was performed successfully. She was discharged on aspirin and ticagrelor, without rate-limiting drugs, as her baseline heart rate was 60 bpm. Two weeks later, she developed dizziness and dyspnea (NYHA III). ECG showed 2:1 Mobitz type II AV block with a ventricular rate of 40 bpm. Repeat angiography confirmed a patent stent, and thyroid profile was normal. Holter monitoring corroborated persistent AV block. Ticagrelor was discontinued and replaced with clopidogrel, resulting in the restoration of sinus rhythm. On follow-up, the patient remained asymptomatic with normal ECG findings. Ticagrelor can rarely induce clinically significant AV block even in the absence of other rate-limiting drugs. Clinicians should maintain a high index of suspicion when post-PCI patients on ticagrelor present with bradyarrhythmias. Withdrawal of ticagrelor should be considered before resorting to pacemaker implantation, thereby preventing unnecessary interventions.

This study aimed to investigate the effect of indobufen combined with clopidogrel compared with clopidogrel alone on the efficacy and serum inflammatory factors (transforming growth factor-beta [TGF-β], interkeukin [IL]-6) in patients after percutaneous transluminal angioplasty (PTA) for arteriovenous fistula (AVF). A retrospective cohort study was conducted, enrolling 120 patients after AVF-PTA. Patients were divided into the combination therapy group (indobufen + clopidogrel) and the conventional therapy group (clopidogrel alone) by propensity score matching, with 60 patients in each group. The clinical efficacy at 7 days postoperatively, changes in AVF blood flow volume/velocity, changes in serum TGF-β/IL-6 levels, and restenosis rates at 3 and 6 months postoperatively were compared between the 2 groups. The total clinical effective rate at 7 days postoperatively was significantly higher in the combination therapy group (91.7% vs 76.7%, P = .024), with more significant improvements in AVF blood flow volume and velocity (both P < .001). The combination therapy group showed greater reductions in serum TGF-β and IL-6 levels postoperatively (both P < .01). The restenosis rates were significantly lower in the combination group at 3 months (6.7% vs 20.0%, P = .038) and 6 months (15.0% vs 36.7%, P = .006) postoperatively, with higher primary patency rates (P = .004). Indobufen combined with clopidogrel can more effectively improve early postoperative efficacy and AVF function after AVF-PTA, significantly suppress the expression of inflammatory factors, and reduce the risk of short- to medium-term restenosis. Its mechanism may be related to synergistic antiplatelet and anti-inflammatory effects.

Antithrombotic agents are among the most frequently prescribed medications in elderly patients and are essential for the prevention and treatment of cardiovascular and cerebrovascular diseases. Although cutaneous adverse reactions associated with anticoagulants and antiplatelet agents are generally considered uncommon, dermatologists frequently encounter these medications when evaluating patients presenting with pruritic eruptions. This apparent discrepancy may be explained by differences in patient populations. While cardiologists and neurosurgeons manage all patients receiving antithrombotic therapy, dermatologists evaluate a selected population enriched for cutaneous symptoms. This review summarizes the spectrum of cutaneous adverse reactions associated with major antithrombotic agents, including warfarin, heparins, aspirin, ticlopidine, clopidogrel, cilostazol, prasugrel, and direct oral anticoagulants (DOACs). Reported reactions range from common hemorrhagic manifestations to delayed-type hypersensitivity reactions; severe cutaneous adverse reactions, such as drug reaction with eosinophilia and systemic symptoms (DRESS/DIHS), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), vasculitis, and skin necrosis. Particular emphasis is placed on drug-specific dermatologic phenotypes and diagnostic approaches, including drug-induced lymphocyte stimulation testing, patch testing, and clinicopathological correlation. In addition, Japanese case reports published between 1980 and 2024 are reviewed and integrated with the international literature. These data suggest that antithrombotic agents should not be regarded as a homogeneous dermatologic risk category. Instead, each drug class exhibits characteristic cutaneous reaction patterns that may assist in the differential diagnosis of these reactions in clinical practice. Recognition of these drug-specific phenotypes may facilitate earlier diagnosis, improve interdisciplinary communication, and optimize the management of suspected antithrombotic drug eruptions.

Platelets are anucleate cells that can be studied by benchtop flow cytometers and today there are several types of flow cytometric assays for platelets. Platelet structure studies in clinical flow cytometry mostly target rare congenital platelet glycoprotein deficiencies (e.g., Glanzmann-thrombasthenia, and Bernard-Soulier syndrome) that can be considered as the prototypes for platelet flow analysis, since the identification of complete or partial deficiency of these molecules provides the proper diagnosis. Another area of platelet flow cytometry is the detection of activated platelets. Mostly it means the gold standard platelet P-selectin assay or the investigation of PAC-1 binding-an assay where the activation dependent epitope of the GPIIb/IIIa receptor is investigated-but the measurement of platelet-leukocyte aggregates and microparticle analysis have gained increasing role. A unique platelet subtype is the subgroup designated as coated platelets that are formed by the simultaneous activation with collagen and thrombin. In clinical practice further functional assays are also informative tests: the monitoring of clopidogrel resistance by measuring the intracellular phosphorylated VASP and identifying heparin induced thrombocytopenia (HIT) by the use of patient plasma. The flow cytometric HIT test utilize the detection of phosphatidylserine expression on normal platelets or the formation of microparticles in the presence of the patient's plasma and therapeutic concentration of heparin, thus it seems reasonable to suggest it for the study of the functionality of the HIT antibodies. Nevertheless, there are also limitations to these assays as several of them require fresh samples, thus sample transport to specialized laboratories is not always feasible.

Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) reduces thrombotic risk in acute coronary syndrome (ACS) but may increase bleeding, especially in chronic kidney disease (CKD). This study evaluated the impact of different DAPT durations on cardiovascular and bleeding outcomes in ACS patients with and without CKD. Using the Taiwan National Health Insurance Research Database (2001-2018), patients ≥20 years with ACS who underwent PCI and received clopidogrel plus aspirin for ≥1 month were analyzed. Primary outcomes were cardiovascular events and bleeding events. Subgroup analysis was conducted by CKD status, which was defined using claims-based International Classification of Diseases, Ninth and Tenth Revision (ICD-9/ICD-10) diagnostic codes. Among 4,800 patients with ACS identified (median age: 62 years; 77% male), there were no significant differences in cardiovascular events across DAPT duration groups. No associations between DAPT duration and cardiovascular outcomes were identified in patients with or without CKD. However, DAPT duration ≥7 months was associated with a higher incidence of other major bleeding in patients with CKD (adjusted odds ratio [aOR] = 29.7, 95% confidence interval [CI]: 1.80-491.05, p = 0.018). In patients undergoing PCI for ACS, no clear association was observed between longer DAPT duration and reduced cardiovascular events. In prespecified subgroup analyses, prolonged DAPT was associated with a higher incidence of bleeding events among patients with claims-defined CKD; however, this finding should be interpreted as exploratory given the observational design and low event rates. These results highlight the importance of individualized decision-making regarding DAPT duration, particularly in patients with increased bleeding susceptibility.