Duration of Triple Antithrombotic Therapy and Outcomes Among Patients Undergoing Percutaneous Coronary Intervention.

Koskinas, Konstantinos; Räber, Lorenz; Zanchin, Thomas; Pilgrim, Thomas; Stortecky, Stefan; Hunziker, Lukas; Blöchlinger, Stefan; Billinger, Michael; Gartwyl, Fabienne; Moro, Christina; Moschovitis, Aris; Jüni, Peter; Heg, Dik; Windecker, Stephan (2016). Duration of Triple Antithrombotic Therapy and Outcomes Among Patients Undergoing Percutaneous Coronary Intervention. JACC. Cardiovascular Interventions, 9(14), pp. 1473-1483. Elsevier 10.1016/j.jcin.2016.04.027

[img] Text
1-s2.0-S1936879816304654-main.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (1MB) | Request a copy

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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Koskinas, Konstantinos; Räber, Lorenz; Pilgrim, Thomas; Stortecky, Stefan; Hunziker, Lukas; Blöchlinger, Stefan; Billinger, Michael; Moschovitis, Aris; Heg, Dierik Hans and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Judith Liniger

Date Deposited:

12 Dec 2016 09:19

Last Modified:

03 Jan 2017 14:18

Publisher DOI:

10.1016/j.jcin.2016.04.027

PubMed ID:

27478115

Uncontrolled Keywords:

anticoagulation; antiplatelet; bleeding; coronary intervention

BORIS DOI:

10.7892/boris.89702

URI:

https://boris.unibe.ch/id/eprint/89702

Actions (login required)

Edit item Edit item
Provide Feedback