Journal article
Duration of Triple Antithrombotic Therapy and Outcomes Among Patients Undergoing Percutaneous Coronary Intervention.
- Koskinas KC Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Räber L Department of Cardiology, Bern University Hospital, Bern, Switzerland. Electronic address: lorenz.raeber@insel.ch.
- Zanchin T Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Pilgrim T Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Stortecky S Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Hunziker L Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Blöchlinger S Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Billinger M Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Gartwyl F Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Moro C Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Moschovitis A Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- Jüni P Department of Medicine, University of Toronto, Toronto, Canada.
- Heg D Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
- Windecker S Department of Cardiology, Bern University Hospital, Bern, Switzerland.
- 2016-08-02
Published in:
- JACC. Cardiovascular interventions. - 2016
anticoagulation
antiplatelet
bleeding
coronary intervention
Acute Coronary Syndrome
Administration, Oral
Aged
Aged, 80 and over
Anticoagulants
Chi-Square Distribution
Coronary Artery Disease
Coronary Thrombosis
Drug Administration Schedule
Drug Therapy, Combination
Female
Fibrinolytic Agents
Hemorrhage
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction
Percutaneous Coronary Intervention
Platelet Aggregation Inhibitors
Proportional Hazards Models
Registries
Retrospective Studies
Risk Factors
Stroke
Switzerland
Time Factors
Treatment Outcome
English
OBJECTIVES
The aim of this study was to compare clinical outcomes in relation to the duration of triple antithrombotic therapy (TAT) among patients with indications for oral anticoagulation undergoing percutaneous coronary intervention (PCI).
BACKGROUND
TAT is recommended for patients undergoing PCI with a firm indication for oral anticoagulation. Duration of TAT may influence outcomes, but the optimal period of TAT remains uncertain.
METHODS
Between 2009 and 2013, 8,772 consecutive patients undergoing PCI for stable coronary artery disease or acute coronary syndrome were prospectively included in the Bern PCI Registry (NCT02241291). Of 568 patients with indications for oral anticoagulation, 245 (43%) were discharged on a regimen of 1-month TAT and 323 (57%) on a regimen >1-month TAT (mean 5.1 ± 3.3 months, median 3 months). The primary endpoint was a composite of cardiac death, myocardial infarction, stroke, definite stent thrombosis, or TIMI (Thrombolysis in Myocardial Infarction) major bleeding within 1 year.
RESULTS
Patients on 1-month compared with >1-month TAT were more commonly women, with stable coronary artery disease, had higher HAS-BLED scores, and less frequently received drug-eluting stents. In multivariate analyses, the primary endpoint did not differ between groups (adjusted hazard ratio: 1.07; 95% confidence interval: 0.56 to 2.06; p = 0.84). Results were consistent in stratified analyses in relation to clinical presentation with acute coronary syndrome (38%) and PCI with drug-eluting stents (79%) (p for interaction = 0.18 and 0.95, respectively). There were no differences in the secondary bleeding endpoint, Bleeding Academic Research Consortium ≥3 bleeding (adjusted hazard ratio: 0.62; 95% confidence interval: 0.21 to 1.80; p = 0.37) and the secondary composite ischemic endpoint (cardiac death, myocardial infarction, stroke, or definite stent thrombosis) (adjusted hazard ratio: 1.12; 95% confidence interval: 0.55 to 2.29; p = 0.76).
CONCLUSIONS
One-month TAT, used preferentially in patients with higher estimated bleeding risk in this observational study, was associated with similar net clinical outcomes compared with longer TAT durations throughout 1 year following PCI.
The aim of this study was to compare clinical outcomes in relation to the duration of triple antithrombotic therapy (TAT) among patients with indications for oral anticoagulation undergoing percutaneous coronary intervention (PCI).
BACKGROUND
TAT is recommended for patients undergoing PCI with a firm indication for oral anticoagulation. Duration of TAT may influence outcomes, but the optimal period of TAT remains uncertain.
METHODS
Between 2009 and 2013, 8,772 consecutive patients undergoing PCI for stable coronary artery disease or acute coronary syndrome were prospectively included in the Bern PCI Registry (NCT02241291). Of 568 patients with indications for oral anticoagulation, 245 (43%) were discharged on a regimen of 1-month TAT and 323 (57%) on a regimen >1-month TAT (mean 5.1 ± 3.3 months, median 3 months). The primary endpoint was a composite of cardiac death, myocardial infarction, stroke, definite stent thrombosis, or TIMI (Thrombolysis in Myocardial Infarction) major bleeding within 1 year.
RESULTS
Patients on 1-month compared with >1-month TAT were more commonly women, with stable coronary artery disease, had higher HAS-BLED scores, and less frequently received drug-eluting stents. In multivariate analyses, the primary endpoint did not differ between groups (adjusted hazard ratio: 1.07; 95% confidence interval: 0.56 to 2.06; p = 0.84). Results were consistent in stratified analyses in relation to clinical presentation with acute coronary syndrome (38%) and PCI with drug-eluting stents (79%) (p for interaction = 0.18 and 0.95, respectively). There were no differences in the secondary bleeding endpoint, Bleeding Academic Research Consortium ≥3 bleeding (adjusted hazard ratio: 0.62; 95% confidence interval: 0.21 to 1.80; p = 0.37) and the secondary composite ischemic endpoint (cardiac death, myocardial infarction, stroke, or definite stent thrombosis) (adjusted hazard ratio: 1.12; 95% confidence interval: 0.55 to 2.29; p = 0.76).
CONCLUSIONS
One-month TAT, used preferentially in patients with higher estimated bleeding risk in this observational study, was associated with similar net clinical outcomes compared with longer TAT durations throughout 1 year following PCI.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.jcin.2016.04.027
- PMID 27478115
- Persistent URL
- https://sonar.rero.ch/global/documents/269589
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