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. 2023 Mar 8;23(1):117.
doi: 10.1186/s12872-023-03161-7.

Trends in antiplatelet strategies 12-months following coronary stent placement in anticoagulated patients

Eleni M Gamvroulas  1 , Aubrey E Jones  2 , John A Saunders  3 , Tara L Jones  3 , Daniel M Witt  4
Affiliations

Trends in antiplatelet strategies 12-months following coronary stent placement in anticoagulated patients

Eleni M Gamvroulas et al. BMC Cardiovasc Disord. .

Abstract

Background: Antithrombotic guidelines for patients undergoing percutaneous coronary interventions (PCIs) and also requiring anticoagulant medications are evolving. This study describes changes to antithrombotic therapy and associated outcomes 12-months following PCI in patients requiring ongoing anticoagulation therapy.

Methods: Records of patients identified from queries of electronic medical records were manually reviewed to verify changes to antithrombotic therapy from discharge to 12-months and at 12-months following PCI, and episodes of major bleeding, clinically relevant non-major bleeding (CRNMB), major adverse cardiovascular or neurological events (MACNE), and all-cause mortality outcomes during an additional 6-months follow-up.

Results: Patients (n = 120) receiving anticoagulation therapy at 12-months post PCI were classified into the following groups according to antiplatelet therapy status: no antiplatelet therapy (n = 16), single antiplatelet therapy (SAPT) (n = 85), and dual antiplatelet therapy (DAPT) (n = 19). Between 12- and 18-months following PCI there were 2 major bleeds, 7 CRNMB, 6 MACNE, 2 venous thromboembolisms, and 5 deaths. All but one bleeding episode occurred in the SAPT group. The odds of remaining on DAPT at 12-months were higher in patients who had PCI for acute coronary syndrome (odds ratio [OR] 2.91, 95% confidence interval [CI] 0.96, 8.77), and in those experiencing MACNE in the 12-months following PCI (OR 1.95, 95% CI 0.67, 5.66), but these associations were not statistically significant.

Conclusion: Most anticoagulated patients were continued on antiplatelet therapy 12-months post PCI. Bleeding was numerically more common in anticoagulated patients continuing SAPT therapy beyond 12 months. There was significant variability in antithrombotic prescribing patterns 12-months post PCI suggesting a potential opportunity for standardizing care in this patient population.

Keywords: Antiplatelet therapy; Atrial fibrillation; Drug eluting stent; Percutaneous coronary intervention; Venous thromboembolism.

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Conflict of interest statement

Daniel Witt is supported by grant funding from Roche Diagnostics (RD003737) and the Agency for Healthcare Research and Quality (R18 HS27960). Aubrey Jones is supported by grant funding from the National Heart Lung and Blood Institute (K23HL157751).

Figures

Fig. 1
Fig. 1
Overview of study patient identification, flow, and outcomes. MACNE- major adverse cardiovascular or neurological events
See this image and copyright information in PMC

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