Balancing Long-Term Risks of Ischemic and Bleeding Complications After Percutaneous Coronary Intervention With Drug-Eluting Stents

Matteau, Alexis; Yeh, Robert W.; Camenzind, Edoardo; Steg, Philippe Gabriel; Wijns, William; Mills, Joseph; Gershlick, Anthony; Belder, Mark de; Ducrocq, Grégory; Mauri, Laura

doi:10.1016/j.amjcard.2015.05.036

Cited by 58 publications

(33 citation statements)

References 39 publications

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“…19 Prior studies have demonstrated that smoking is associated with worse clinical outcomes following stent placement in other locations as well. In a study of Ͼ9000 patients undergoing percutaneous coronary intervention with drug-eluting stents, Matteau et al 20 found that smoking was an independent risk factor for postoperative ischemic events and bleeding. Similar to patients with PEDs, patients with percutaneous coronary intervention are required to receive dual antiplatelet therapy following their intervention.…”

Section: Discussionmentioning

confidence: 99%

Smoking Does Not Affect Occlusion Rates and Morbidity-Mortality after Pipeline Embolization for Intracranial Aneurysms

Rouchaud¹,

Brinjikji²,

Cloft³

et al. 2016

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

Smoking Does Not Affect Occlusion Rates and Morbidity-Mortality after Pipeline Embolization for Intracranial Aneurysms

Rouchaud¹,

Brinjikji²,

Cloft³

et al. 2016

AJNR Am J Neuroradiol

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“…Можно также по-лагать, что у большинства больных ожидаемая вероят-ность ТО существенно превосходит вероятность кровоте-чений. В пользу данного предположения свидетельствуют анализ популяций PROTECT и PROTECT US, объеди-нивший 9727 больных, которые подвергались ЧКВ и на-блюдались на протяжении 4 лет [26]. Определенные на основании многофакторного анализа предикторы ТО и ГО оказались тесно связаны между собой.…”

Section: оценка риска развития тромботических осложнений у больных ибunclassified

Prognostic significance of DAPT scale and D-Dimer level in patients treated with elective PCI

Комаров¹,

Новикова²,

Dobrovolsky³

et al. 2018

Kardio. vestn.

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1 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия; 2 ФГБОУ ВО «Московский государственный университет им. М.В. Ломоносова», Москва, Россия Цель исследования. Изучить взаимосвязь балльной оценки по шкале DAPT и коагулологического показателя -D-димера с развитием тромботических и геморрагических осложнений (ГО) на фоне двухкомпонентной антитромбоцитарной терапии (ДАТТ) и после ее прекращения у больных, подвергнутых плановым процедурам чрескожного коронарного вмешательства (ЧКВ). Материал и методы. В исследование (2012-2013 гг.) были включены 188 больных со стабильной формой ишемической болезни ИБС, подвергнутых плановым ЧКВ и получающих ДАТТ на протяжении 6-12 мес после вмешательства. Ретроспективно рассчитана балльная оценка по шкале DAPТ. Определение D-димера в образцах венозной крови проводилось методом иммуноферментного анализа накануне ЧКВ. Медиана периода проспективного наблюдения составила 651 день, минимальный период -23 дня, максимальный -1476 дней. Регистрировались тромботические осложнения (ТО): сердечно-сосудистая смерть, острый коронарный синдром, ишемический инсульт, транзиторная ишемическая атака, тромбоз периферических артерий, тромбоэмболия легочной артерии. ГО оценивали по классификации BARC (Bleeding Academic Research consortium, 2011). Результаты. За период наблюдения частота тромботических исходов и кровотечений (2-5-й тип по классификации BARC) составила 15,4 и 12,2% соответственно. Из всех больных, включенных в исследование, у 100 (53,2%) получена высокая оценка по шкале DAPT (≥2 баллов), у 88 (46,8%) -низкая (<2 баллов). Высокая оценка по шкале DAPT (≥2 баллов) ассоциировалась с увеличением шанса развития ТО в 3,12 раза (95% доверительный интервал 1,1-8,3; p=0,01). Уровень D-димера имел экспоненциальную зависимость от возраста обследованных больных. Высокий уровень D-димера (≥292 нг/мл для лиц моложе 65 лет, ≥610 нг/мл для лиц старше 65 лет) был связан с развитием ТО, риск которого увеличивался в 2,6 раза (95% ДИ от 1,0 до 6,9; р=0,04) после прекращения ДАТТ. Заключение. Пациенты со стабильной ИБС, подвергаемые ЧКВ, характеризуются высокой частотой развития ТО (15,4% за 2 года наблюдения). Предикторами ТО, возникающих после прекращения ДАТТ, являются высокая оценка по шкале DAPT (≥2 баллов) и высокий уровень D-димера. Aim. To study the association between DAPT score, haemostatic factor -D-dimer and prognosis of thrombotic and bleeding events in patients with stable coronary artery disease (CAD), receiving dual antiplatelet therapy (DAPT) after elective percutaneous coronary intervention (PCI). Маterial and methods. The study (2012-2013 years) included 188 patients with stable CAD after elective PCI on DAPT for 6-12 months after the procedure. Individual DAPT score was calculated in patients retrospectively. D-dimer level was assessed by ELISA method the day before PCI. The median of follow-up period was 651 days (min -23 days and max -1476 days). Registered thrombotic events: cardiovascular death, acute coronary syndrome, stroke/transien...

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“…Unfortunately, the information to recommend choices based on individual patient risks is scarce, especially beyond 1 year of DES placement and DAPT. There are many common risk factors associated with individual patient risks of ischemia and bleeding[47]. …”

Section: Antiplatelet Medicationmentioning

confidence: 99%

“…Two large studies, the Patient Related Outcomes With Endeavor vs Cypher Stenting Trial (PROTECT), and PROTECT US, determined that at a median follow-up of 4.1 years, major bleeding occurred in 2.8% subjects and ischemic events in 6.3%[47]. There was no difference in mortality or stroke[56].…”

Section: Antiplatelet Medicationmentioning

confidence: 99%

Organ transplantation and drug eluting stents: Perioperative challenges

Dalal¹

2016

WJT

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Patients listed for organ transplant frequently have severe coronary artery disease (CAD), which may be treated with drug eluting stents (DES). Everolimus and zotarolimus eluting stents are commonly used. Newer generation biolimus and novolimus eluting biodegradable stents are becoming increasingly popular. Patients undergoing transplant surgery soon after the placement of DES are at increased risk of stent thrombosis (ST) in the perioperative period. Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor such as clopidogrel, prasugrel and ticagrelor is instated post stenting to decrease the incident of ST. Cangrelor has recently been approved by Food and Drug Administration and can be used as a bridging antiplatelet drug. The risk of ischemia vs bleeding must be considered when discontinuing or continuing DAPT for surgery. Though living donor transplant surgery is an elective procedure and can be optimally timed, cadaveric organ availability is unpredictable, therefore, discontinuation of antiplatelet medication cannot be optimally timed. The type of stent and timing of transplant surgery can be of utmost importance. Many platelet function point of care tests such as Light Transmittance Aggregrometry, Thromboelastography Platelet Mapping, VerifyNow, Multiple Electrode Aggregrometry are used to assess bleeding risk and guide perioperative platelet transfusion. Response to allogenic platelet transfusion to control severe intraoperative bleeding may differ with the antiplatelet drug. In stent thrombosis is an emergency where management with either a drug eluting balloon or a DES has shown superior outcomes. Post-transplant complications often involved stenosis of an important vessel that may need revascularization. DES are now used for endovascular interventions for transplant orthotropic heart CAD, hepatic artery stenosis post liver transplantation, transplant renal artery stenosis following kidney transplantation, etc. Several antiproliferative drugs used in the DES are inhibitors of mammalian target of rapamycin. Thus they are used for post-transplant immunosuppression to prevent acute rejection in recipients with heart, liver, lung and kidney transplantation. This article describes in detail the various perioperative challenges encountered in organ transplantation surgery and patients with drug eluting stents.

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Balancing Long-Term Risks of Ischemic and Bleeding Complications After Percutaneous Coronary Intervention With Drug-Eluting Stents

Abstract: Introduction-While trials comparing antiplatelet strategies after coronary intervention report average risks of bleeding and ischemia in a population, there is limited information to guide choices based on individual patient risks, particularly beyond one year after treatment.

Cited by 58 publications

References 39 publications

Smoking Does Not Affect Occlusion Rates and Morbidity-Mortality after Pipeline Embolization for Intracranial Aneurysms

Smoking Does Not Affect Occlusion Rates and Morbidity-Mortality after Pipeline Embolization for Intracranial Aneurysms

Prognostic significance of DAPT scale and D-Dimer level in patients treated with elective PCI

Organ transplantation and drug eluting stents: Perioperative challenges

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