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Preoperative Cessation of Both Dual Anti-Platelet Agents Is Safe after 1 Year in Patients Receiving Percutaneous Coronary Intervention
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논문 기본 정보

Type
Academic journal
Author
Journal
한국지질동맥경화학회(구 한국지질학회) 지질·동맥경화학회지 지질·동맥경화학회지 제9권 제2호 KCI Accredited Journals
Published
2020.1
Pages
304 - 312 (9page)

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Preoperative Cessation of Both Dual Anti-Platelet Agents Is Safe after 1 Year in Patients Receiving Percutaneous Coronary Intervention
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Objective The aim of this study was to investigate the atherothrombotic and bleeding risk of discontinuing both components of dual antiplatelet therapy (DAPT) before surgery in patients with an intracoronary stent after 1 year. Methods We retrospectively enrolled 212 patients who received an evaluation of perioperative cardiac risk and underwent surgery from March 2017 to March 2019. We divided them into 2 groups: the discontinuation of both antiplatelet agents group (DCAP, no use of any antiplatelet agent) and the continuation of at least 1 antiplatelet agent group (CAP). The primary composite endpoint was the occurrence of major adverse cardiovascular events (MACE), including death, angina, postoperative coronary angiography, stroke, and readmission within 30 days postoperatively. The second endpoint was bleeding requiring the transfusion of ≥2 packs of red blood cells (RBCs) Result A total of 136 patients were enrolled in the study, with 68 in the DCAP group and 68 in the CAP group. The occurrence of MACE did not significantly differ between the groups (25% vs. 17.6%, p=0.295). The incidence of bleeding that required a transfusion was higher in the CAP group (16.2% vs. 30.9%, p=0.044). The postoperative change in hemoglobin levels (−1.9 g/dL vs. −1.8 g/dL, p=0.742), and the number of transfused packs of RBCs (3.5 vs. 5.3, p=0.347) were not significantly different between the groups. Conclusion Preoperative discontinuation of DAPT did not increase the risk of MACE. However, continuation of at least 1 antiplatelet agent increased the incidence of bleeding requiring RBC transfusion. Further research with a large cohort is warranted.

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References (12)

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Banerjee S / 2017 / Use of antiplatelet therapy/DAPT for post-PCI patients undergoing noncardiac surgery / J Am Coll Cardiol 69:1861~1870 google schola Kałuza GL / 2000 / Catastrophic outcomes of noncardiac surgery soon after coronary stenting / J Am Coll Cardiol 35:1288~1294 google schola Levine GN / 2016 / 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease : a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines / J Thorac Cardiovasc Surg 152:1243~1275 google schola Burger W / 2005 / Low-dose aspirin for secondary cardiovascular prevention-cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation-review and meta-analysis / J Intern Med 257:399~414 google schola Oscarsson A / 2010 / To continue or discontinue aspirin in the perioperative period : a randomized, controlled clinical trial / Br J Anaesth 104:305~312 google schola

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