Key result
Thrombin generation was significantly higher immediately after PCI compared to 4 weeks later (3,178 vs 2,378 nM; p=0.005) and remained constant after aspirin withdrawal.
Why the study?
The optimal antithrombotic treatment for patients with AF undergoing PCI is controversial, as dual therapy is safer than triple therapy but its efficacy remains unclear.
Does aspirin withdrawal from triple therapy alter thrombin generation in patients with atrial fibrillation undergoing percutaneous coronary intervention?
Observational (n=23)
Does aspirin withdrawal from triple therapy alter thrombin generation in patients with atrial fibrillation undergoing percutaneous coronary intervention?
Absolute Event Rate: 3178% vs 2378%
p-value: p=0.005
Thrombin generation remains constant after aspirin withdrawal at 4 weeks post-PCI in AF patients, suggesting dual therapy provides a similar antithrombotic effect to triple therapy at this stage.
BACKGROUND: The optimal antithrombotic treatment for patients with atrial fibrillation (AF) that undergo percutaneous coronary intervention (PCI) is controversial. Dual therapy (clopidogrel and a direct oral anticoagulant [DOAC]) is safer than triple therapy (warfarin, aspirin, and clopidogrel), while efficacy is unclear. We aimed to evaluate thrombin generation (TG) under dual and triple therapy. METHODS: A noninterventional prospective trial in patients with AF undergoing PCI. Patients received 4 weeks of triple therapy with aspirin, clopidogrel, and a DOAC followed by aspirin withdrawal. TG was measured in platelet-rich plasma (PRP) and platelet-poor plasma (PPP) at 3 five to 21 points, day 1 after PCI (TIME 0), 4 weeks after PCI (TIME 1), and 2 weeks after aspirin withdrawal (TIME 2). RESULTS: Twenty-three patients (18 men, median age 78 years, 83% with acute coronary syndrome) were included. Endogenous thrombin potential (ETP) in PPP was high at TIME 0 compared with TIME 1 (ETP 3,178 ± 248 nM vs. 2,378 ± 222 nM, p = 0.005). These results remained consistent when measured in PRP. No significant difference in ETP was found before (TIME 1) and after aspirin withdrawal (TIME 2) although few patients had high ETP levels after stopping aspirin. CONCLUSIONS: TG potential is high immediately after PCI and decreases 4 weeks after PCI in patients receiving triple therapy. TG remains constant after aspirin withdrawal in most patients, suggesting that after 1 month the antithrombotic effect of dual therapy may be similar to triple therapy.
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Gurevitz et al. (2021) conducted an observational in Atrial fibrillation undergoing percutaneous coronary intervention (n=23). Aspirin withdrawal (transition from triple to dual therapy) vs. Triple therapy (before aspirin withdrawal) was evaluated on Endogenous thrombin potential (ETP) in platelet-poor plasma (PPP) at day 1 vs 4 weeks after PCI (p=0.005). Thrombin generation was significantly higher immediately after PCI compared to 4 weeks later (3,178 vs 2,378 nM; p=0.005) and remained constant after aspirin withdrawal.
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