Bleeding-Related Deaths in Relation to the Duration of Dual-Antiplatelet Therapy After Coronary Stenting

Palmerini, Tullio; Reggiani, Maria Letizia Bacchi; Riva, Diego Della; Romanello, Mattia; Feres, Fausto; Abizaid, Alexandre; Gilard, Martine; Morice, Marie Claude; Valgimigli, Marco; Hong, Myeong Ki; Kim, Byeong Keuk; Jang, Yangsoo; Kim, Hyo Soo; Park, Kyung Woo; Colombo, Antonio; Chieffo, Alaide; Ahn, Jung Min; Park, Seung Jung; Schüpke, Stefanie; Kastrati, Adnan; Montalescot, Gilles; Steg, Philippe Gabriel; Diallo, Abdourahmane; Vicaut, Éric; Helft, Gérard; Biondi‐Zoccai, Giuseppe; Xu, Bo; Han, Yaling; Généreux, Philippe; Bhatt, Deepak L.; Stone, Gregg W.

doi:10.1016/j.jacc.2017.02.029

Cited by 114 publications

(72 citation statements)

References 29 publications

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“…Similarly, 2 year follow up of the ITALIC trial of 1850 patients randomized to 6 versus 24 month of DAPT after DES PCI found no difference in ischemic or bleeding endpoints, although there was a trend to higher mortality with longer DAPT (2.2% vs 1.2%; P = 0.11) . The same trend was seen by Palmerini et al through a meta‐analysis of six RCTs linking shorter DAPT with a lower all‐cause mortality, and lower rates of bleeding related death (HR: 0.65; 95%CI: 0.43‐0.99; P = 0.04). Given the mechanistic plausibility of the authors' finding, bleeding risk should be individually assessed prior to prolonging DAPT.…”

Section: Dual Antithrombotic Therapy After Pcisupporting

confidence: 76%

Percutaneous coronary intervention: 2017 in review

Rao

Sheth

Grines

2018

J Interven Cardiology

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In an effort to keep the interventional community up-to-date with the abundant amount of new data, we have selected what we believe to be the most important publications in percutaneous coronary intervention from January 1, 2017 to 2 The overall rate of complete revascularization (CR) was 61.7%.In those patients with CR, there was no difference between CABG or PCI regarding death from any cause as well as composite of death, MI, and stroke at 5 year follow up, even at higher SYNTAX scores.However, compared to CABG with CR, PCI with incomplete revascularization put patients at a significant higher risk for similar endpoints. These studies suggest that the ability to achieve CR should be strongly considered when deciding between CABG and PCI in MVD.As we have learned from contemporary data on revascularization, certain subsets of patients have fared better with one revascularization strategy over another. An observational cohort study of multiple Swedish registries found that in patients with Type 1 diabetes and MVD, first multi-vessel revascularization with PCI was associated with higher risk of cardiac death, MI, and repeat revascularization although with similar all-cause mortality when compared to CABG. 3 This study indicates that CABG may be the preferred strategy in patients with Type 1 diabetes in need of multi-vessel revascularization, and is in agreement with earlier trials showing most of the benefit in patients treated with insulin, but not oral agents.In patients with low or intermediate SYNTAX score, PCI of unprotected left main with everolimus-eluting stents (EES) was shown to be noninferior to CABG with respect to a composite endpoint of death, stroke, and MI at 3 years in the EXCEL trial. 4 Of the 1905 patients randomized during the trial, 1788 patients were also followed for quality of life assessment to fully understand patient's perspective.

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Section: Dual Antithrombotic Therapy After Pcisupporting

confidence: 76%

Percutaneous coronary intervention: 2017 in review

Rao

Sheth

Grines

2018

J Interven Cardiology

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“…First, bleeding complications are associated with adverse outcomes after PCI [12], risk stratification is important for such patients to enable an appropriate therapeutic approach for each individual case. In contemporary primary PCI, the occurrence of access site bleeds is rare even in high risk population [27,28].…”

Section: Discussionmentioning

confidence: 99%

“…Dual antiplatelet therapy (DAPT) with aspirin and a P2Y 12 inhibitor reduces ischaemic recurrences in patients with ACS treated with percutaneous coronary intervention (PCI), but increases bleeding [7]. In this regard, approximately half of the major bleeds in patients aged 75 years or older are gastrointestinal bleeding (GIB) [8], an uncommon but devastating complication of regular antiplatelet use is intracerebral haemorrhage (ICH) [9].…”

Section: Introductionmentioning

confidence: 99%

“…Of note, the identification of distinct predictors for antiplateletrelated bleeding complications may provide opportunities to further tailor post-PCI care for those at high bleeding risk, yet studies dedicated to the risk predictors of antiplateletrelated bleeding complications after PCI in Chinese elderly people are rarely done [3,6,11]. Furthermore, bleeding is strongly associated with the occurrence of mortality within one year after bleeding complications [12]. Timely cessation of antiplatelet therapy is a critical component of the successful management of antiplatelet-related bleeding complications in patients with ACS [13].…”

Section: Introductionmentioning

confidence: 99%

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Predictors and Management of Antiplatelet-Related Bleeding Complications for Acute Coronary Syndrome in Chinese Elderly Patients

Wan

Zhou

Liu

et al. 2018

Cell Physiol Biochem

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Background/Aims: Bleeding complications after percutaneous coronary intervention (PCI) are strongly associated with adverse patient outcomes. However, there are no specific guidelines for the predictors and management of antiplatelet-related bleeding complications in Chinese elderly patients with acute coronary syndrome (ACS). Methods: A retrospective analysis of 237 consecutive patients (aged ≥ 75 years) with ACS who had undergone successful PCI from January 2010 to December 2016 was performed to identify predictors and management of antiplatelet-related bleeding complications. Multivariate logistic regression analysis was conducted to investigate independent predictors of antiplatelet-related bleeding complications. We defined antiplatelet-related bleeding complications as first hospitalization received long-term oral antiplatelet therapy and required hospitalization, including gastrointestinal and intracranial bleedings. Results: After multivariable adjustment, independent risk predictors of antiplatelet-related bleeding complications included female gender (odds ratio [OR]: 2.96; 95% confidence interval [CI]: 1.98 to 4.15; P = 0.011), body mass index (OR: 1.54; 95% CI: 1.06 to 1.94; P = 0.034), previous history of bleeding (OR: 4.03; 95% CI: 1.84 to 6.12; P = 0.004), fasting blood glucose (OR: 2.79; 95% CI: 1.23 to 4.46; P = 0.025), and chronic total occlusion lesion (OR: 4.69; 95% CI: 2.19 to 7.93; P = 0.007). Of 46 patients with antiplatelet-related bleeding complications, 54.3% were treated short-term dual antiplatelet therapy (DAPT) cessation (0–7 days) and 45.7% underwent long-term DAPT cessation (> 7 days). Among these, 14 patients presented major adverse cardiac and cerebrovascular events (MACCE), whereas no re-bleeding happened over all available follow-up. The incidence of MACCE was not significantly different between the two groups one year after PCI (36.0% for short-term DAPT cessation versus 23.8% for long-term DAPT cessation, P = 0.522). Conclusion: For elderly patients with ACS, multiple factors were likely to contribute to antiplatelet-related bleeding complications, especially previous history of bleeding and chronic total occlusion lesion. Better individualized, tailored and risk-adjusted antiplatelet therapy after PCI is urgently needed in this high-risk population.

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“…20 Of note, this inferiority may induce bleeding-related death. To explore whether single antiplatelet therapy could reduce the risk of bleeding, an open-label, multicentre, randomised, controlled trial was induced.…”

Section: Rational For Single Antiplatelet Therapymentioning

confidence: 99%

The Development of Antiplatelet Therapy after Percutaneous Coronary Intervention

Duan

Gong

2017

IPMRJ

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Coronary artery disease is one of the common cardiovascular diseases and threatens our health. Percutaneous coronary intervention (PCI) is the main treatment for coronary artery disease. Bare-metal stents (BMS) and drug-eluting stents (DES) are popularly applied in clinical practice. With the development of clinic and technology, DES is widely used in coronary artery disease following antiplatelet therapy. Clinical guidelines require dual antiplatelet therapy (DAPT) after PCI in USA and Europe. It is effective to reduce the incident of stent thrombosis, myocardial infarction and major adverse cardiac. However, the risk of major adverse cardiac events and bleeding was increased by DAPT. Therefore, single antiplatelet therapy was induced in various clinical trials. We searched previous research from PubMed, Embase Web of Science

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Bleeding-Related Deaths in Relation to the Duration of Dual-Antiplatelet Therapy After Coronary Stenting

Cited by 114 publications

References 29 publications

Percutaneous coronary intervention: 2017 in review

Percutaneous coronary intervention: 2017 in review

Predictors and Management of Antiplatelet-Related Bleeding Complications for Acute Coronary Syndrome in Chinese Elderly Patients

The Development of Antiplatelet Therapy after Percutaneous Coronary Intervention

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