scholarly journals Long-term outcomes of triple antithrombotic therapy (TT) versus dual antiplatelet therapy (NoTT) after coronary stenting: up to 4-years of follow-up

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P4822-P4822
Author(s):  
A. De La Rosa ◽  
R. Del Castillo ◽  
L. Hernando ◽  
E. Canovas ◽  
P. Salinas ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Antithrombotic Therapy ◽  
Dual Antiplatelet Therapy ◽  
Coronary Stenting ◽  
Long Term Outcomes ◽  
Triple Antithrombotic Therapy

scholarly journals Long-term ischemic and bleeding risk with extended dual antiplatelet therapy after PCI in patients with 2018 ESC/EACTS myocardial revascularization guideline-endorsed high thrombotic risk features

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
HY Wang ◽  
D Yin ◽  
L Feng ◽  
CG Zhu ◽  
KF Dou
Keyword(s):  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Cox Model ◽  
Myocardial Revascularization ◽  
Coronary Stenting ◽  
Lesion Length ◽  
Diabetic Patients ◽  
Thrombotic Risk

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Beijing Municipal Health Commission (Grant number: 2020–1-4032) Background The ischemic/bleeding trade-off of continuing dual antiplatelet therapy (DAPT) beyond 1 year after PCI for patients with high thrombotic risk (HTR) as endorsed by 2018 ESC/EACTS myocardial revascularization guidelines remain unknown. We sought to evaluate the benefits and harms of DAPT with aspirin and clopidogrel beyond 1 year versus ≤ 1-year DAPT on long-term clinical outcomes after PCI with DES among ESC/EACTS guideline-endorsed HTR patients that are event-free at 1 year follow-up, using a prospective, real-world registry. Methods Patients undergoing coronary stenting between January 2013 and December 2013 from the prospective Fuwai registry were defined as HTR if they met at least 1 ESC/EACTS guideline-endorsed HTR criteria with at least 1 of the following characteristics: diffuse (lesion length ≥ 20 mm) multivessel disease in diabetic patients, CKD (estimated glomerular filtration rate < 60 mL/min), ≥ 3 stents implanted, ≥ 3 lesions treated, bifurcation with 2 stents implanted, total stent length > 60 mm, treatment of CTO, and history of STEMI. A total of 4578 patients who were at HTR and were events free at 1 year after the index procedure were evaluated. The primary efficacy outcome was major adverse cardiac and cerebrovascular events (MACCE) (composite of all-cause death, myocardial infarction, or stroke). Results Median follow-up period was 2.4 years. > 1-year DAPT with clopidogrel and aspirin significantly reduced the risk of MACCE compared with ≤ 1-year DAPT (1.9% vs. 4.6%; hazard ratio (HR): 0.38; 95% confidence interval (CI): 0.27–0.54; P < 0.001), driven by a reduction in all-cause death (0.2% vs. 3.0%; HR, 0.07; 95% CI, 0.03–0.15). Cardiac death and definite/ probable stent thrombosis also occurred less frequently in prolonged DAPT group. Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding occurred similarly between both groups (1.1% vs. 0.9%; HR, 1.11; 95% CI, 0.58–2.13; P = 0.763). Similar results were found using multivariable Cox model, propensity score-matched, and inverse probability of treatment weighting analysis. Conclusions Among patients with ESC-endorsed HTR who were free from major ischemic or bleeding events 1 year after coronary stenting, continued DAPT beyond 1 year might offer better effectiveness in terms of atherothrombotic events and comparable safety in terms of clinically relevant bleeding compared with ≤ 1-year DAPT. ESC-HTR criteria is an important parameter to take into account in tailoring DAPT prolongation.

Anticoagulation in addition to dual antiplatelet therapy has no impact on long-term follow-up after endovascular treatment of (sub)acute lower limb ischemia

VASA ◽  
2019 ◽  
Vol 48 (4) ◽  
pp. 321-329
Author(s):  
Mariya Kronlage ◽  
Erwin Blessing ◽  
Oliver J. Müller ◽  
Britta Heilmeier ◽  
Hugo A. Katus ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Limb Ischemia ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Short Term ◽  
Long Term Follow Up

Summary. Background: To assess the impact of short- vs. long-term anticoagulation in addition to standard dual antiplatelet therapy (DAPT) upon endovascular treatment of (sub)acute thrombembolic occlusions of the lower extremity. Patient and methods: Retrospective analysis was conducted on 202 patients with a thrombembolic occlusion of lower extremities, followed by crirical limb ischemia that received endovascular treatment including thrombolysis, mechanical thrombectomy, or a combination of both between 2006 and 2015 at a single center. Following antithrombotic regimes were compared: 1) dual antiplatelet therapy, DAPT for 4 weeks (aspirin 100 mg/d and clopidogrel 75 mg/d) upon intervention, followed by a lifelong single antiplatelet therapy; 2) DAPT plus short term anticoagulation for 4 weeks, followed by a lifelong single antiplatelet therapy; 3) DAPT plus long term anticoagulation for > 4 weeks, followed by a lifelong anticoagulation. Results: Endovascular treatment was associated with high immediate revascularization (> 98 %), as well as overall and amputation-free survival rates (> 85 %), independent from the chosen anticoagulation regime in a two-year follow up, p > 0.05. Anticoagulation in addition to standard antiplatelet therapy had no significant effect on patency or freedom from target lesion revascularization (TLR) 24 months upon index procedure for both thrombotic and embolic occlusions. Severe bleeding complications occurred more often in the long-term anticoagulation group (9.3 % vs. 5.6 % (short-term group) and 6.5 % (DAPT group), p > 0.05). Conclusions: Our observational study demonstrates that the choice of an antithrombotic regime had no impact on the long-term follow-up after endovascular treatment of acute thrombembolic limb ischemia whereas prolonged anticoagulation was associated with a nominal increase in severe bleeding complications.

scholarly journals Lower GI Bleeding is More Common Than Upper on Dual Antiplatelet Therapy When PPI Use is High: Long-Term Follow-up of a 1221 Patient Cohort

2011 ◽  
Vol 140 (5) ◽  
pp. S-137-S-138 ◽  
Author(s):  
Ruben Casado-Arroyo ◽  
Mónica Polo-Tomás ◽  
Pilar Roncales ◽  
James M. Scheiman ◽  
Angel Lanas
Keyword(s):  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Gi Bleeding ◽  
Patient Cohort ◽  
Long Term Follow Up ◽  
Lower Gi Bleeding

scholarly journals Impact of Diabetes Mellitus on Antithrombotic Management Patterns and Long‐Term Clinical Outcomes in Patients With Acute Coronary Syndrome: Insights From the EPICOR Asia Study

2020 ◽  
Vol 9 (22) ◽  
Author(s):  
Shaoyi Guan ◽  
Xiaoming Xu ◽  
Yi Li ◽  
Jing Li ◽  
Mingzi Guan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Antiplatelet Agents ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Antithrombotic Management

Background Long‐term use of antiplatelet agents after acute coronary syndrome in diabetic patients is not well known. Here, we describe antiplatelet use and outcomes in such patients enrolled in the EPICOR Asia (Long‐Term Follow‐up of Antithrombotic Management Patterns in Acute Coronary Syndrome Patients in Asia) registry. Methods and Results EPICOR Asia is a prospective, observational study of 12 922 patients with acute coronary syndrome surviving to discharge, from 8 countries/regions in Asia. The present analysis included 3162 patients with diabetes mellitus (DM) and 9602 patients without DM. The impact of DM on use of antiplatelet agents and events (composite of death, myocardial infarction, and stroke, with or without any revascularization; individual components, and bleeding) was evaluated. Significant baseline differences were seen between patients with DM and patients without DM for age, sex, body mass index, cardiovascular history, angiographic findings, and use of percutaneous coronary intervention. At discharge, ≈90% of patients in each group received dual antiplatelet therapy. At 2‐year follow‐up, more patients with DM tended to still receive dual antiplatelet therapy (60% versus 56%). DM was associated with increased risk from ischemic but not major bleeding events. Independent predictors of the composite end point of death, myocardial infarction, and stroke in patients with DM were age ≥65 years and use of diuretics at discharge. Conclusions Antiplatelet agent use is broadly comparable in patients with DM and patients without DM, although patients with DM are more likely to be on dual antiplatelet therapy at 2 years. Patients with DM are at increased risk of ischemic events, suggesting an unmet need for improved antithrombotic treatment. Registration URL: https://www.clini​caltr​ials.gov ; Unique identifier: NCT01361386.

P2554Bleedings during antithrombotic therapy: a blessing in disguise

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Cosmi ◽  
B Mariottoni ◽  
F Cosmi
Keyword(s):  
Antithrombotic Therapy ◽  
Dual Antiplatelet Therapy ◽  
Heart Diseases ◽  
New Anticoagulants ◽  
Bleeding Score ◽  
One Year ◽  
Triple Antithrombotic Therapy ◽  
Diagnosis Of Diseases ◽  
Diagnostic Investigations

Abstract Background and purpose Antithrombotic therapy in patients with heart diseases is associated with minor and major, sometimes fatal bleedings. On the other hand, bleeding can favor the diagnosis of diseases that have a significant impact on patient's prognosis. In our research, we evaluated the incidence of occult malignancies associated with bleeding during antithrombotic therapy. Methods In the last 5 years, we evaluated 20,154 outpatients. We found that antithrombotic therapy was performed in 9.356 (46%) of subjects. Of these, 6,560 took an antiplatelet monotherapy. 658 were on dual antiplatelet therapy, 465 were anticoagulated with warfarin, 1,154 received new anticoagulants, 145 were on triple antithrombotic therapy, and 354 patients took one anticoagulant plus an antiplatelet. Twenty patients who already had a diagnosis of malignancy were excluded from the analysis. In a one year follow-up, we evaluated the incidence of minor, major and fatal bleedings. All patients with bleedings and suspicion for occult malignancies underwent further diagnostic investigations. Results Table 1 shows the incidence of bleeding (classified according to the ISTH bleeding score). Overall, there were 1,045 bleeds, of which 289 (3.1%) were major, and 756 (8.1%) minor. In 2 cases the bleeding was fatal (0.2%). Malignancies were identified in 88 patients (8.4%); in 72 cases (82%) the treatment was resolutive. Table 1. Rates of major and minor bleedings and occult malignancies Bleedings Major Occult malignancies Minor Occult malignancies Gastrointestinal 130 (1.4%) 15 (5.1%) 289 (3.1%) 45 (6.0%) Urinary 46 (0.5%) 6 (2.1%) 207 (2.2%) 14 (1.8%) Musculo-cutaneous 30 (0.3%) – 47 (0.5%) Epistaxis and airways 36 (0.4%) – 198 (2.1%) 8 (1.0%) Intracranial 28 (0.3%) – – – Ocular 9 (0.1%) – 15 (0.2%) – Intraarticular 10 (0.1%) – – – Others – – – Total 289 (3.1%) 21 (7.2%) 756 (8.1%) 67 (8.8%) Conclusions Our research underlines the importance of prosecuting diagnostic investigations even in patients with minor bleedings, especially in case of gastrointestinal or urinary bleedings, to exclude cancer, since there were no significant differences in the incidence of malignancies between the two groups.

scholarly journals Impact of known or new-onset atrial fibrillation on 2-year cardiovascular event rate in patients with acute coronary syndromes: results from the prospective EPICOR Registry

2018 ◽  
Vol 8 (2) ◽  
pp. 121-129 ◽  
Author(s):  
Uwe Zeymer ◽  
Lieven Annemans ◽  
Nicolas Danchin ◽  
Stuart Pocock ◽  
Simon Newsome ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Oral Anticoagulants ◽  
Composite Endpoint ◽  
Coronary Syndrome ◽  
Long Term Follow Up ◽  
New Onset

Background: Atrial fibrillation (AF) is associated with increased morbidity in acute coronary syndrome patients, but impact on outcomes beyond 1 year is unclear. Methods: This was a post-hoc analysis from the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) registry (NCT01171404), a prospective, observational study conducted in Europe and Latin America, which enrolled acute coronary syndrome survivors at discharge. Antithrombotic management patterns, mortality, a composite endpoint of death/new non-fatal myocardial infarction/stroke and bleeding events were assessed after 2 years of follow-up in patients with or without AF. Results: Of 10,568 patients enrolled, 397 (4.7%) had prior AF and 382 (3.6%) new-onset AF during index hospitalisation. Fewer patients with AF underwent percutaneous coronary intervention (52.1% vs. 66.6%; P<0.0001). At discharge, fewer AF patients received dual antiplatelet therapy (71.6% vs. 89.5%; P<0.0001); oral anticoagulant use was higher in AF patients but was still infrequent (35.0% vs. 2.5%; P<0.0001). Use of dual antiplatelet therapy and oral anticoagulants declined over follow-up with over 50% of all AF/no AF patients remaining on dual antiplatelet therapy (55.6% vs. 60.6%), and 23.3% (new-onset AF) to 42.1% (prior AF) on oral anticoagulants at 2 years. At 2 years, mortality, composite endpoint and bleeding rates were higher in AF patients (all P<0.0001) compared to patients without AF. On multivariable analysis, the risk of mortality or the composite endpoint was significant for prior AF ( P=0.003, P=0.001) but not new-onset AF ( P=0.88, P=0.92). Conclusions: Acute coronary syndrome patients with AF represent a high-risk group with increased event rates during long-term follow-up. Prior AF is an independent predictor of mortality and/or ischaemic events at 2 years. Use of anticoagulants in AF after acute coronary syndrome is still suboptimal.

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