Key result
Double therapy fails to reduce bleeding requiring transfusion versus triple therapy in OAC-treated PCI patients.
Why the study?
The safest and most effective periprocedural antithrombotic regimen in PCI patients on oral anticoagulant therapy had not been fully investigated.
Does double therapy (OAC + single antiplatelet) reduce in-hospital bleeding compared to triple therapy (OAC + dual antiplatelet) in patients on OAC undergoing PCI?
Cohort (n=26,938)
Yes
Does double therapy (OAC + single antiplatelet) reduce in-hospital bleeding compared to triple therapy (OAC + dual antiplatelet) in patients on OAC undergoing PCI?
Odds Ratio: 0.7 (95% CI 0.42–1.16)
p-value: p=0.165
In patients on oral anticoagulation undergoing PCI, periprocedural double therapy did not significantly reduce in-hospital bleeding compared to triple therapy but was associated with a higher risk of stent thrombosis.
Observational data associate antithrombotic regimens with in-hospital bleeding in OAC-treated PCI patients; leaves open optimal strategy pending randomized trials.
The type of periprocedural antithrombotic regimen that is the safest and most effective in percutaneous coronary intervention (PCI) patients on oral anticoagulant (OAC) therapy has not been fully investigated. We aimed to retrospectively investigate the in-hospital bleeding outcomes of patients receiving OAC and antiplatelet therapies during PCI using Japanese nationwide multicenter registry data. A total of 26,938 patients who underwent PCI with OAC and antiplatelet therapies between 2016 and 2017 were included. We investigated in-hospital bleeding requiring blood transfusion, mortality, and stent thrombosis according to the antithrombotic regimens used at the time of PCI: OAC + single antiplatelet therapy (double therapy) and OAC + dual antiplatelet therapy (triple therapy). The antiplatelet agents included aspirin, clopidogrel, and prasugrel. The OAC agents included warfarin and direct OACs. Adjusting the dose of OAC or intermitting OAC before PCI was at each operator's discretion. In the study population [mean age (SD), 73.5 (9.5) years; women, 21.5%], the double therapy and triple therapy groups comprised 5546 (20.6%) and 21,392 (79.4%) patients, respectively. Bleeding requiring transfusion was not significantly different between the groups [adjusted odds ratio (aOR), 0.700; 95% confidence interval (CI), 0.420-1.160; P = 0.165] (triple therapy as a reference). Mortality was not significantly different (aOR, 1.370; 95% CI, 0.790-2.360; P = 0.258). Stent thrombosis was significantly different between the groups (aOR, 3.310; 95% CI, 1.040-10.500; P = 0.042) (triple therapy as a reference). In conclusion, for patients on OAC therapy who underwent PCI, periprocedural triple therapy may be safe with respect to in-hospital bleeding risks. However, further investigations are warranted to establish the safety and efficacy of periprocedural triple therapy.
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Yashima et al. (2021) conducted a cohort in PCI patients on oral anticoagulant (OAC) therapy (n=26,938). OAC + single antiplatelet therapy (double therapy) vs. OAC + dual antiplatelet therapy (triple therapy) was evaluated on In-hospital bleeding requiring blood transfusion (aOR 0.700, 95% CI 0.420-1.160, p=0.165). Double therapy did not significantly reduce in-hospital bleeding requiring transfusion compared to triple therapy in PCI patients on oral anticoagulants (aOR 0.700; 95% CI 0.420-1.160; P=0.165).
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