Kelley Branch, MD: Considerations for Dual Antiplatelet Therapy, Anticoagulation

In a session at the American College of Physicians (ACP) Internal Medicine Meeting in Boston this past weekend, Kelley Branch, MD, MSc, professor in the division of cardiology at the University of Washington Heart Institute, reviewed approaches to the use of antithrombotics for the primary and secondary prevention of cardiovascular disease.

In his introduction at the beginning of the session, Branch described the current landscape as a “very confusing time,” noting his goal was to dissect what the latest data suggests.

In the first segment of an interview with HCPLive, Branch reviewed key points highlighted in the session and described guideline recommendations for primary and secondary prevention of cardiovascular disease. In this segment, he began by explaining circumstances in which dual antiplatelet therapy should be used as well as when it should be discontinued or interrupted.

“There have been lots of strides, not only in the antiplatelet and antithrombotic realms, but also in stents and our therapies and how we approach patients, making sure the stents are deployed, et cetera, so there have been lots of those improvements,” Branch said.

Specifically, in patients at high risk of bleeding, he noted dual antiplatelet therapy should be used for a short period of time and patients should be pulled off relatively early, citing data presented at the American College of Cardiology meeting earlier this year showing this can be as little as 1 month of dual antiplatelet therapy before patients can be transitioned to monotherapy.

Branch also discussed strategies for stroke prevention in valvular versus nonvalvular atrial fibrillation using anticoagulants, describing the importance of distinguishing between the two.

“We really want to be calling this just atrial fibrillation, but there really is a stratification to valvular or nonvalvular,” he said, going on to explain different circumstances in which various anticoagulants may or may not be appropriate for patients.

Branch has relevant disclosures with Bayer, Amgen, Hanmi, Janssen Pharmaceuticals, and Kestra.