Periprocedural temporary discontinuation of dual antiplatelet therapy to single antiplatelet therapy in patients undergoing time-sensitive vascular surgery after second-generation drug-eluting stent implantation

Q: What are the key findings of this study?

Time-sensitive vascular surgery with temporary DAPT discontinuation performed within 180 days of PCI was associated with a trend toward higher all-cause mortality compared to surgery performed at or after 180 days (HR 2.74).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Patients undergoing time-sensitive vascular surgery after second-generation drug-eluting stent implantation (n=185). Intervention: Time-sensitive vascular surgery <180 days post-PCI with temporary DAPT discontinuation vs. Surgery ≥180 days post-PCI. Primary outcome: All-cause mortality (HR 2.74, 95% CI 1.20-6.26, p=0.08).

Kamil Kosmulski; Eugeniusz Hrycek; Przemysław Nowakowski; Piotr Paweł Buszman; Krzysztof P. Milewski; Adam J. Janas; Aleksandra Wesołowska; Aleksander Żurakowski

doi:10.33963/v.phj.114120

August 10, 2026Kardiologia PolskaOpen Access

Periprocedural temporary discontinuation of dual antiplatelet therapy to single antiplatelet therapy in patients undergoing time-sensitive vascular surgery after second-generation drug-eluting stent implantation

View Full Paper

Ask AI

Bookmark

Share

Key result

Vascular surgery within 180 days of PCI is linked to ~2.7-fold higher mortality.

HR 2.74
95% CI 1.20-6.26
P=0.08
n=185

Why the study?

Does periprocedural temporary discontinuation of a P2Y12 inhibitor to single antiplatelet therapy (acetylsalicylic acid) affect the incidence of MACE in patients undergoing time-sensitive vascular surgery after second-generation DES implantation?

Key Points

To evaluate the clinical outcomes and safety of temporarily discontinuing dual antiplatelet therapy to single antiplatelet therapy in patients undergoing time-sensitive vascular surgery after second-generation drug-eluting stent implantation.
Retrospective cohort study of 185 patients who underwent percutaneous coronary intervention with second-generation drug-eluting stents and required time-sensitive vascular surgery between 20 days and 12 months post-procedure.
Dual antiplatelet therapy was de-escalated by discontinuing the P2Y12 inhibitor 5–7 days preoperatively while continuing acetylsalicylic acid (75 mg daily), with P2Y12 inhibitor resumption 1–7 days postoperatively.
No major adverse cardiovascular events (MACE) or deaths occurred perioperatively or within 30 days post-vascular surgery.
Over long-term follow-up, MACE occurred in 32% of patients: all-cause death in 18.4% (n = 34), cardiovascular death in 8.1% (n = 15), myocardial infarction in 8.1% (n = 15), repeat revascularization in 10.3% (n = 19), and stroke in 4.9% (n = 9).
Patients who died had a significantly shorter interval between percutaneous coronary intervention and vascular surgery (median 72 vs. 94 days; P = 0.03), with a trend toward higher all-cause mortality in the <180-day group (hazard ratio, 2.74; 95% confidence interval, 1.20–6.26; P = 0.08).

Study Design

Type

Cohort (n=185)

Multicenter

No

Structured PICO

Does periprocedural temporary discontinuation of a P2Y12 inhibitor to single antiplatelet therapy (acetylsalicylic acid) affect the incidence of MACE in patients undergoing time-sensitive vascular surgery after second-generation DES implantation?

P

Population

185 patients (mean age 69.1 years, 28% female) with a history of PCI and second-generation DES implantation requiring time-sensitive vascular surgery with temporary DAPT discontinuation, followed for a mean of 3.7 years.

E

Exposure

Temporary discontinuation of dual antiplatelet therapy (DAPT) to single antiplatelet therapy by discontinuing the P2Y12 inhibitor 5-7 days before vascular surgery, while continuing acetylsalicylic acid (ASA; 75 mg daily) without interruption. P2Y12 inhibitor therapy was resumed 1-7 days after surgery and continued until 12 months post-PCI.

C

Comparator

Internal cohort comparison stratified by the time interval between PCI and vascular surgery (<90 days vs. ≥90 days and <180 days vs. ≥180 days).

O

Outcome

Composite MACE endpoint (cardiovascular death, myocardial infarction, stroke, or repeat coronary revascularization), all-cause mortality, and cardiovascular mortality.composite

Main Result

Hazard Ratio: 2.74 (95% CI 1.2–6.26)

p-value: p=0.08

Limitations

Retrospective, observational, non-randomized study design
Relatively small sample size (185 patients)
Single-center data limits generalizability
Lack of a control group that did not discontinue DAPT

Implication

Temporary discontinuation of a P2Y12 inhibitor ≥30 days post-PCI with second-generation DES, while continuing aspirin, appears safe for time-sensitive vascular surgery without increasing 30-day MACE.

Abstract

No abstract yet. The journal hasn't published one we can show.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Kosmulski et al. (2026) conducted a cohort in Patients undergoing time-sensitive vascular surgery after second-generation drug-eluting stent implantation (n=185). Time-sensitive vascular surgery <180 days post-PCI with temporary DAPT discontinuation vs. Surgery ≥180 days post-PCI was evaluated on All-cause mortality (HR 2.74, 95% CI 1.20-6.26, p=0.08). Time-sensitive vascular surgery with temporary DAPT discontinuation performed within 180 days of PCI was associated with a trend toward higher all-cause mortality compared to surgery performed at or after 180 days (HR 2.74).

synapsesocial.com/papers/6ad115aa00741cc3fba7d76a https://doi.org/10.33963/v.phj.114120

View Full Paper

Ask AI

Bookmark

Share

Periprocedural temporary discontinuation of dual antiplatelet therapy to single antiplatelet therapy in patients undergoing time-sensitive vascular surgery after second-generation drug-eluting stent implantation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Periprocedural temporary discontinuation of dual antiplatelet therapy to single antiplatelet therapy in patients undergoing time-sensitive vascular surgery after second-generation drug-eluting stent implantation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

More from Kardiologia Polska

Keep reading

More from Kardiologia Polska