Bioresorbable Device Implantation in Left Main in Patients with Limitation For Long-Term Using of Dual Antiplatelet Therapy

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.

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LONG-TERM ISCHEMIC AND BLEEDING RISK WITH EXTENDED DUAL ANTIPLATELET THERAPY AFTER PCI IN HIGH-RISK “TWILIGHT-LIKE” PATIENTS WITH ACUTE CORONARY SYNDROME

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02590-0 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1231

Author(s):

Haoyu Wang ◽

Dong Yin ◽

Bo Xu ◽

Kefei Dou

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Bleeding Risk ◽

Coronary Syndrome

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Long-term clinical efficacy and safety of adding cilostazol to dual antiplatelet therapy for patients undergoing PCI: a meta-analysis of randomized trials with adjusted indirect comparisons

Current Medical Research and Opinion ◽

10.1185/03007995.2013.850067 ◽

2013 ◽

Vol 30 (1) ◽

pp. 37-49 ◽

Cited By ~ 13

Author(s):

Yu Chen ◽

Yachen Zhang ◽

Yong Tang ◽

Xiaohong Huang ◽

Yuquan Xie

Keyword(s):

Antiplatelet Therapy ◽

Clinical Efficacy ◽

Randomized Trials ◽

Dual Antiplatelet Therapy ◽

Meta Analysis ◽

Efficacy And Safety ◽

Indirect Comparisons

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LONG-TERM OUTCOME WITH ORAL ANTICOAGULANTS WITH OR WITHOUT DUAL ANTIPLATELET THERAPY AFTER AMI: THE FAST-MI 2010 REGISTRY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(17)33596-9 ◽

2017 ◽

Vol 69 (11) ◽

pp. 207

Author(s):

Tabassome Simon ◽

Etienne Puymirat ◽

Francois Schiele ◽

Guillaume Cayla ◽

Loic Belle ◽

...

Keyword(s):

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Oral Anticoagulants ◽

Term Outcome ◽

Long Term Outcome

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Abstract 67: Effects of Single vs Dual Antiplatelet Therapy on Long Term Stroke and Death After Carotid Endarterectomy

Stroke ◽

10.1161/str.51.suppl_1.67 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Nathan Belkin ◽

Alexander S Fairman ◽

Benjamin M Jackson ◽

Paul J Foley ◽

Scott M Damrauer ◽

...

Keyword(s):

Logistic Regression ◽

Propensity Score ◽

Carotid Endarterectomy ◽

Propensity Score Matching ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Long Term Effects ◽

Kaplan Meier ◽

One Year

Introduction: Current evidence suggests that dual antiplatelet therapy (DAPT) reduces perioperative stroke, but increases bleeding after carotid endarterectomy (CEA). The long term effects of antiplatelet therapy after CEA have yet to be studied. Methods: A retrospective review of patients undergoing CEA in the national Vascular Quality Initiative database (2003-2018) was performed. Based on antiplatelet regimen at discharge, patients were propensity score matched on aspirin monotherapy vs. DAPT. Multivariable logistic regression and Kaplan-Meier analyses were used to investigate the long term effects of antiplatelet regimen on mortality and stroke/TIA. Results: Of the 72,122 patients undergoing CEA, 64.6% were discharged on aspirin, and 35.4% on DAPT. The DAPT group had higher frequencies of comorbidities (COPD, HTN, CHF, smoking, diabetes) as well as atherosclerotic diseases (PAD, CAD, prior PCI, prior CABG). After propensity score matching, two groups of 8,722 patients with comparable comorbidities were formed. While unmatched Kaplan-Meier analysis showed the DAPT cohort to have higher mortality (p=0.001), this difference dissipated after matching. The resultant matched DAPT cohort did not differ from the aspirin group in one year stroke/TIA (1.7% vs. 1.6%, p=0.70), or mortality (3.1% vs. 3.3%, p=0.55). At 5 years, however, patients treated with DAPT did exhibit a mortality benefit (6.4% vs. 7.3%, p=0.02) with multivariable logistic regression identifying DAPT as an independent predictor of reduced mortality (OR 0.94, 95% CI 0.88-0.99, p=0.04). Conclusions: Patients discharged on DAPT after CEA represent a significantly different cohort than those discharged on aspirin monotherapy. After propensity score matching, there was no difference at one year stroke/TIA or mortality outcomes, but DAPT was found to be protective against long-term mortality. Further study is warranted to investigate this finding.

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