Trends in Antiplatelet Strategies 12-months Following Coronary Stent Placement in Anticoagulated Patients

Abstract Background Antithrombotic guidelines for patients that undergo percutaneous coronary interventions (PCIs) and also require anticoagulant medications are evolving. The objective of this study was to describe changes to antithrombotic therapy and associated outcomes occurring 12-months following PCI in patients requiring ongoing anticoagulation therapy. Methods Records of patients identified from queries of electronic medical records were manually reviewed to verify changes to antithrombotic therapy from discharge to 12-months and at 12-months following PCI, and episodes of major bleeding, clinically relevant non-major bleeding (CRNMB), major adverse cardiovascular or neurological events (MACNE), and all-cause mortality outcomes during an additional 6-months follow-up. Results Patients (n=114) receiving anticoagulation therapy at 12 months post PCI were classified into the following groups according to antiplatelet therapy status at that time: no antiplatelet therapy (n=16), single antiplatelet therapy (SAPT) (n=81), and dual antiplatelet therapy (DAPT) (n=17). During the initial 12 months post PCI, there were 73 outcome events including MACNE (32.5%), major bleeding (8.3%), and CRNMB (13.3%). Between 12- and 18-months following PCI there were 2 major bleeds, 7 CRNMB, 6 MACNE, 2 venous thromboembolisms, and 5 deaths. All but one bleeding episode occurred in the SAPT group. Conclusions Most anticoagulated patients were continued on antiplatelet therapy after 12-months post PCI. Bleeding was numerically more common in anticoagulated patients continuing SAPT therapy beyond 12 months. There was significant variability in antithrombotic prescribing patterns 12-months post PCI suggesting a potential opportunity for standardizing care in this patient population.