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

2018 ◽  
Vol 50 (3) ◽  
pp. 1164-1177 ◽  
Author(s):  
Jindong Wan ◽  
Peijian Wang ◽  
Peng Zhou ◽  
Sen Liu ◽  
Dan Wang ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Antiplatelet Therapy ◽  
Chronic Total Occlusion ◽  
Previous History ◽  
Bleeding Complications ◽  
Short Term ◽  
Total Occlusion ◽  
Coronary Syndrome ◽  
History Of

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.

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 Benefit and Harm of Extended Dual Antiplatelet Therapy After PCI in high-risk TWILIGHT-like patients with acute coronary syndrome

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
HY Wang ◽  
R Zhang ◽  
ZX Cai ◽  
KF Dou
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Antiplatelet Therapy ◽  
Cardiovascular Death ◽  
Secondary Outcome ◽  
Short Term ◽  
Bleeding Events ◽  
Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background Recent emphasis on reduced duration and/or intensity of antiplatelet therapy following PCI irrespective of indication for PCI may fail to account for the substantial risk of subsequent nontarget lesion events in acute coronary syndrome (ACS) patients. This study sought to investigate the benefits and risks of extended-term (>12-month) DAPT as compared with short-term DAPT in high-risk "TWILIGHT-like" ACS patients undergoing PCI. Methods All consecutive patients fulfilling the "TWILIGHT-like" criteria undergoing PCI from January 2013 to December 2013 were identified from the prospective Fuwai PCI Registry. High-risk "TWILIGHT-like" patients were defined by at least 1 clinical and 1 angiographic feature based on TWILIGHT trial selection criteria. The present analysis evaluated 4,875 high-risk "TWILIGHT-like" patients with ACS who were event-free at 12 months after PCI. The primary outcome was the composite of all-cause death, myocardial infarction (MI), or stroke at 30 months while BARC type 2, 3, or 5 bleeding was key secondary outcome. Results Extended DAPT compared with shorter DAPT reduced the composite outcome of all-cause death, MI, or stroke by 63% (1.5% vs. 3.8%; HRadj: 0.374, 95% CI: 0.256 to 0.548; HRmatched: 0.361, 95% CI: 0.221-0.590). The HR for cardiovascular death was 0.049 (0.007 to 0.362) and that for MI 0.45 (0.153 to 1.320) and definite/probable stent thrombosis 0.296 (0.080-1.095) in propensity-matched analyses. Rates of BARC type 2, 3, or 5 bleeding (0.9% vs. 1.3%; HRadj: 0.668 [0.379 to 1.178]; HRmatched: 0.721 [0.369-1.410]) did not differ significantly in patients treated with DAPT > 12-month or DAPT ≤ 12-month. The effect of long-term DAPT on primary and key secondary outcome across the proportion of ACS patients with 1-3, 4-5, or 6-9 risk factors showed a consistent manner (Pinteraction > 0.05). Conclusion Among high-risk "TWILIGHT-like" patients with ACS after PCI, long-term DAPT reduced ischemic events without increasing clinically meaningful bleeding events as compared with short-term DAPT, suggesting that extended DAPT might be considered in the treatment of ACS patients who present with a particularly higher risk for thrombotic complications. Abstract Figure.

LONG TERM SURVIVAL BENEFIT OF CHRONIC TOTAL OCCLUSION REVASCULARIZATION VERSUS CONSERVATIVE TREATMENT IN ELDERLY PATIENTS

2018 ◽  
Vol 71 (11) ◽  
pp. A1055
Author(s):  
Eduardo Flores ◽  
Victoria Martin-Yuste ◽  
Ignacio Ferreira-Gonzalez ◽  
Guillem Caldentey ◽  
Sara Vazquez ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Elderly Patients ◽  
Survival Benefit ◽  
Chronic Total Occlusion ◽  
Total Occlusion ◽  
Term Survival ◽  
Long Term Survival

scholarly journals TCT-368 Long-Term Clinical Outcome in Elderly Patients (≥75 years) Versus Younger Patients (<75 years) Undergoing PCI for Chronic Total Occlusion

2013 ◽  
Vol 62 (18) ◽  
pp. B116
Author(s):  
Stephen O'Connor ◽  
Thierry Lefevre ◽  
Francesca Sanguineti ◽  
Yusuke Watanabe ◽  
Thomas Hovasse ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Elderly Patients ◽  
Chronic Total Occlusion ◽  
Total Occlusion ◽  
Younger Patients

MO783CENTRAL VEIN STENOSIS IN HEMODIALYSIS PATIENTS WITH PAST CENTRAL VEIN MANIPULATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Pedro Reis Pereira ◽  
Círia Sousa ◽  
Natalia Silva ◽  
Jose Francisco ◽  
Mónica Fructuoso ◽  
...  
Keyword(s):  
Vascular Access ◽  
Significant Proportion ◽  
Previous History ◽  
Hemodialysis Patients ◽  
Brachiocephalic Vein ◽  
Central Vein ◽  
Central Venous ◽  
Short Term ◽  
History Of

Abstract Background and Aims Central vein stenosis (CVS) is frequently observed in hemodialysis patients. Risk factors for CVS include prior ipsilateral central venous catheterization (CVC) and cardiac rhythm device (CRD) insertions. Though it may have clinical manifestations, CVS is often asymptomatic and, therefore, not diagnosed. The aim of this work was to evaluate the prevalence of CVS in a population of hemodialysis patients, as well as underlying risk factors, clinical manifestations and impact in patients’ vascular access. Method We retrospectively evaluated all venous angiographies of prevalent patients in our hemodialysis units from 2013 to 2018. In patients with proved CVS, we evaluated history of prior short term and long term upper ipsilateral CVC and CRD insertions. We also analyzed symptoms associated CVS as well as the rate of loss of vascular access for hemodialysis related to the presence of CVS. Results The prevalence of CVS in prevalent patients in hemodialysis during the period of our study (n=209) was 14%. We identified 31 upper CVS in 29 patients undergoing venous angiography. Left brachiocephalic vein was the most commonly affected site (45.1% of cases), followed by the right brachiocephalic vein (19.3%), left subclavian vein (16.1%), right subclavian vein (12.9%) and superior vena cava (6.4%). The majority of patients with CVS (95%) had previous history of ipsilateral CVC (previous short-term CVC in 40%, pervious short term and long-term CVC in 27% and previous long-term CVC in 33%). Loss of vascular access for hemodialysis due do CVS was observed in 26% of patients with CVS. Conclusion A significant proportion of patients in hemodialysis presents CVS. The majority of patients with CVS had a previous history of ipsilateral central venous catherization. A significant proportion of patients with CVS had a previous history central venous catherization uniquely with short term CVC, highlighting the importance of the risk of vascular lesion, even during short periods of catherization. The presence of CVS is associated with a significant rate of loss hemodialysis vascular access.

The Bleeding Risk in Antithrombotic Therapies: A Narrative Review

2020 ◽  
Vol 18 (3) ◽  
pp. 237-248 ◽  
Author(s):  
Adriano Alatri ◽  
Lucia Mazzolai
Keyword(s):  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Risk Scores ◽  
Short Term ◽  
Coronary Syndrome ◽  
Important Complication ◽  
Percutaneous Coronary

Bleeding represents the most important complication of antithrombotic treatment, including anticoagulant and antiplatelet therapies. A number of scores were proposed to evaluate the risk of bleeding both for anticoagulant and antiplatelet treatment. In the last decade, 5 bleeding risk scores were published for use in atrial fibrillation patients, and 3 scores for patients receiving anticoagulants for venous thromboembolism therapy or prophylaxis. In addition, 3 scores were recently developed to assess inhospital or short-term bleeding risk in patients receiving antiplatelet therapy after Acute Coronary Syndrome (ACS) and Percutaneous Coronary Intervention (PCI). Furthermore, 3 additional scores have focused on long-term bleeding in outpatients receiving dual antiplatelet therapy after PCI. The aim of this review is to consider the evidence on bleeding scores.

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