The aim of this study was to compare clinical outcomes in relation to the duration of triple antithrombotic therapy in patients with indications for oral anticoagulation undergoing coronary angioplasty. The optimal period for the prescription of these three drugs has not been studied.
Between 2009 and 2013, 8772 consecutive patients undergoing coronary angioplasty were included in the Bern PCI Registry. Of 568 patients with indications for oral anticoagulation in the aforementioned registry, 245 (43%) were discharged on 1-month triple antithrombotic therapy and 323 (57%) on a regimen of over 1 month (mean 5.1 ± 3.3 months). The primary endpoint was a composite of cardiac death, acute myocardial infarction, stroke, definite stent thrombosis, or TIMI (Thrombolysis in Myocardial Infarction) major bleeding at 1 year.
Patients on a regime of 1-month triple antithrombotic therapy were more commonly clinically stable women with a higher risk of bleeding who received drug-eluting stents less frequently.
In the multivariate analysis, the primary endpoint turned out to be similar between groups (hazard ratio [HR]: 1.07; 95% confidence interval [CI]: 0.56 to 2.06; p = 0.84). These results were consistent in stratified analyses according to clinical presentation and stent type.
There were no differences neither in the secondary endpoint bleeding, or in Bleeding Academic Research Consortium (BARC) ≥3 bleeding, nor in the ischemic secondary endpoint (cardiac death, acute myocardial infarction, stroke, or definite thrombosis).
Conclusion
In this observational study, as regards net clinical outcomes, a 1-month triple antithrombotic therapy was similar to longer triple antithrombotic therapy durations.
Original title: Duration of Triple Antithrombotic Therapy and Outcomes Among Patients Undergoing Percutaneous Coronary Intervention.
Reference: Konstantinos C. et al. J Am Coll Cardiol Intv. 2016;9(14):1473-1483.
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