Aspirin Discontinuation in Patients Requiring Oral Anticoagulation Undergoing Percutaneous Coronary Intervention, The Ro
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SHORT COMMUNICATION
Aspirin Discontinuation in Patients Requiring Oral Anticoagulation Undergoing Percutaneous Coronary Intervention, The Role of Procedural Complexity Mohammad Alkhalil 1,2
&
Michael Shahmohammadi 1 & Mark S. Spence 1 & Colum G. Owens 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The prognostic role of procedural complexity when discontinuing aspirin in patients on oral anticoagulation undergoing percutaneous coronary intervention (PCI) has never been studied. Methods Ischaemic events were compared in 256 consecutive patients according to procedural complexity and aspirin on discharge. PCI complexity was defined according to the high-risk features for ischaemic events in the current guidelines Results Forty percent patients had stable presentation. In patients with complex PCI, ischaemic events were significantly higher when discharged without aspirin (adjusted HR 3.66, (95% CI 1.07 to 12.47), P = 0.038). This was driven from both target vessel failure and de-novo coronary lesions. Ischaemic events were comparable between patients with complex PCI on aspirin and those who underwent non-complex PCI. Conclusions Procedural complexity in patients with indication for oral anticoagulation undergoing PCI should be factored in when deciding optimal antithrombotic therapies. Aspirin discontinuation in patients with high-risk PCI features should be discouraged. Keywords Atrial fibrillation . PCI . Complex
Introduction The management of atrial fibrillation (AF) includes commencing patients on oral anticoagulation, while percutaneous coronary intervention (PCI) necessitates dual antiplatelet therapy [1]. The co-existence of AF and PCI promoted the recommendation to combine anticoagulation and dual antiplatelet as triple therapy (TT) [1]. Nonetheless, such combination has caused two- to three-fold increase in bleeding events and highlighted the need for new strategies to mitigate this risk [1]. Recent studies demonstrated that the combination of single antiplatelet and oral anticoagulation (dual therapy) reduced bleeding events [2–4], but this was offset by higher risk of ischaemic events when compared to TT [5]. Importantly, the
included patients in studies comparing dual versus TT were likely to be managed medically, challenging the applicability of the reported data when tackling complex procedures in realworld patients [6]. Complexity of coronary anatomy has been shown to be associated with ischaemic events [1, 7]; nonetheless, it has never been factored in decision-making regarding antithrombotic treatment in patients with AF undergoing PCI. We sought to investigate the incidence of cardiovascular events in consecutive patients with indication for oral anticoagulation undergoing PCI according to their hospital discharge antithrombotic regimes, considering the complexity of coronary interventional procedure and anatomy.
Methods * Mohammad Alkhalil [email protected] 1
Cardiology Department, Royal Victoria Hospital, Belfast, UK
2
Cardiology Department,
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