Dual Antiplatelet Therapy After Percutaneous Coronary Intervention With Stent Implantation in Patients Taking Chronic Oral Anticoagulation

Rogacka, Renata; Chieffo, Alaide; Michev, Iassen; Airoldi, Flavio; Latib, Azeem; Cosgrave, John; Montorfano, Matteo; Carlino, Mauro; Sangiorgi, Giuseppe; Castelli, Alberto; Godino, Cosmo; Magni, Valeria; Aranzulla, Tiziana Claudia; Romagnoli, Enrico; Colombo, Antonio

doi:10.1016/j.jcin.2007.11.004

Cited by 82 publications

(54 citation statements)

References 25 publications

(16 reference statements)

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“…In a smaller retrospective cohort, DES implantation in patients receiving OAC significantly reduced TVR, compared with BMS, with no increase in major or minor bleeding events. 8 In contrast, another propensity scorematched cohort demonstrated that DES implantation was associated with a higher rate of major bleeding, vs. BMS, with similar rates of ischemic events. 6 …”

Section: Discussionmentioning

confidence: 97%

Bare-Metal vs. Drug-Eluting Stents in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

Kiviniemi

Puurunen

Schlitt

et al. 2014

Circ J

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Section: Discussionmentioning

confidence: 97%

Bare-Metal vs. Drug-Eluting Stents in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

Kiviniemi

Puurunen

Schlitt

et al. 2014

Circ J

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“…24 Atrial fibrillation afflicts more than 2.4 million Americans, and warfarin or targeted anticoagulants are used to treat those at high risk of arterial embolism. 8 The use of any AT is known to predispose the patient to developing cSDH, and it is well accepted that these agents should be stopped at presentation and reversed in the case of warfarin.…”

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confidence: 99%

Timing of the resumption of antithrombotic agents following surgical evacuation of chronic subdural hematomas: a retrospective cohort study

Guha

Coyne

Macdonald

2016

JNS

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C hroniC subdural hematoma (cSDH) is a disease of the elderly and demonstrates an incidence of approximately 3.4 patients per 100,000 persons younger than 65 years of age and 8 to 58 patients per 100,000 persons older than 65 years. 1,4,9 The prevalence of cSDH is expected to rise as the percentage of the United States population older than 65 years grows from 12% in 2003 to a projected 20% by 2030. 17Other identified risk factors for the development of cSDH include male sex, history of falls, chronic alcohol use, and antiplatelet or anticoagulant therapy, with warfarin increasing the relative risk of developing cSDH by aBBreViatiONS ADP = adenosine diphosphate; ASA = acetylsalicylic acid; AT = antithrombosis; CAD = coronary artery disease; cSDH = chronic subdural hematoma; DVT = deep venous thrombosis; INR = international normalized ratio; LMWH = low-molecular-weight heparin; TIA = transient ischemic attack. OBJectiVe Antithrombosis (AT), defined here as either antiplatelets or anticoagulants, is a significant risk factor for the development of chronic subdural hematomas (cSDHs). Resuming AT following the evacuation of cSDH is a highly variable practice, with scant evidence in the literature for guidance. Here, a retrospective analysis of a cohort of patients from a single institution undergoing surgical drainage of cSDH was performed to evaluate postoperative complications and determine the optimal timing of the resumption of common antithrombotic agents. methOdS This retrospective analysis was performed on 479 patients undergoing surgical evacuation of cSDH at St. Michael's Hospital over a 5-year period (2007)(2008)(2009)(2010)(2011)(2012). The collected variables included the type of AT agent, indications for AT, timing and type of postoperative complications, and the restart intervals for the AT agents, when available. Postoperative complications were classified as major hemorrhages, minor hemorrhages, or thromboembolic events. reSultS Among all 479 study patients, 71 experienced major hemorrhage (14.8%), 110 experienced minor hemorrhage (23.0%), and 8 experienced thromboembolism (1.67%) postoperatively. Patients on any type of preoperative AT regimen were at a higher risk of major hemorrhage (19.0% vs 10.9%; OR 1.93; 95% CI 1.15-2.71; p = 0.014). The type of AT agent did not affect the frequency of any postoperative complications. Patients on any preoperative AT regimen experienced earlier postoperative major hemorrhages (mean 16.2 vs 26.5 days; p = 0.052) and thromboembolic events (mean 2.7 vs 51.5 days; p = 0.036) than those patients without a history of AT; the type of AT agent did not affect timing of complications. Patients who were restarted on any AT therapy postoperatively were at decreased risk of major rebleeding following resumption than those patients who were not restarted (OR 0.06; 95% CI 0.02-0.2; p < 0.01). cONcluSiONS Patients with a history of preoperative AT experienced thromboembolic complications significantly earlier than those patients without AT, which peaked at 3 days postoperative...

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“…However, we did adjust for warfarin use, which is strongly associated with atrial fibrillation 35 and atrial fibrillation is the most common reason for anticoagulation in patients with PCI. 36 Because bleeding was a composite and site reported, rather than adjudicated, end point we were unable to evaluate associations using different definitions or severity of bleeding. We enrolled limited number of patients with CrCl <30 mL/min, precluding risk estimates in this group.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Impact of High Platelet Reactivity in Chronic Kidney Disease

Baber

Mehran

Kirtane

et al. 2015

Circ: Cardiovascular Interventions

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A dverse cardiovascular events, including cardiac death and stent thrombosis, are markedly increased among those with versus without chronic kidney disease (CKD) after percutaneous coronary intervention (PCI).1-3 Residual atherothrombotic risk remains excessive among such patients even when treated with contemporary pharmacotherapy or novel stent platforms, including second-generation drug-eluting stents (DES). 4,5 Despite the strong epidemiological links between renal impairment and thrombotic risk, underlying causal and mechanistic insights have not been fully elucidated.High platelet reactivity (HPR) to adenosine diphosphate during clopidogrel therapy has also emerged as a strong and Background-Chronic kidney disease (CKD) is associated with increased rates of adverse events after percutaneous coronary intervention. We sought to determine the impact of CKD on platelet reactivity in clopidogrel-treated patients and whether high platelet reactivity (HPR) confers a similar or differential risk for adverse events among patients with CKD and non-CKD. Methods and Results-We performed a post hoc analysis of the Assessment of Dual Antiplatelet Therapy With DrugEluting Stents (ADAPT-DES) registry, which included 8582 patients undergoing percutaneous coronary intervention with drug-eluting stents and platelet function testing using the VerifyNow assay. We compared HPR and its impact on ischemic and bleeding events >2 years among patients with CKD and non-CKD. Patients with CKD (n=1367) were older, more often female, diabetic, and had lower ejection fraction compared with their non-CKD counterparts (n=7043). Although HPR prevalence increased with worsening renal function in unadjusted analyses, these associations were no longer present after adjustment. Major adverse cardiac event rates at 2 years among those without CKD or HPR, HPR alone, CKD alone, and both CKD and HPR were 9.0%, 11.2%, 13.3%, and 17.5%, respectively (P<0.001). Associations between HPR and adverse events were uniform across CKD strata without evidence of interaction. Conclusions-HPR is more common among those with versus without CKD, an association that is attributable to confounding risk factors that are more prevalent in CKD. The impact of HPR on ischemic and bleeding events is similar irrespective of CKD status. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.(Circ Cardiovasc Interv. 2015;8:e001683.

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Dual Antiplatelet Therapy After Percutaneous Coronary Intervention With Stent Implantation in Patients Taking Chronic Oral Anticoagulation

Abstract: While receiving triple therapy, major bleeding occurred in 4.7% of patients; one-half of the events were lethal, and most occurred within the first month.

Cited by 82 publications

References 25 publications

Bare-Metal vs. Drug-Eluting Stents in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

Bare-Metal vs. Drug-Eluting Stents in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

Timing of the resumption of antithrombotic agents following surgical evacuation of chronic subdural hematomas: a retrospective cohort study

Prevalence and Impact of High Platelet Reactivity in Chronic Kidney Disease

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