AI Article Synopsis

  • International guidelines recommend using direct oral anticoagulants (DOAC) over vitamin K antagonists (VKA) and dual antithrombotic therapy (DAT) over triple antithrombotic therapy (TAT) for patients on oral anticoagulant therapy undergoing percutaneous coronary intervention (PCI) with stents.
  • A study involving 1234 patients on oral anticoagulants assessed the outcomes of DOAC versus VKA and DAT versus TAT, focusing on net adverse clinical events (NACE) at a one-year follow-up.
  • Results showed DOAC resulted in a lower NACE rate compared to VKA (16% vs 23%), and while DAT and TAT had similar NACE rates, DAT led to

Article Abstract

In patients on oral anticoagulant (OAC) therapy undergoing percutaneous coronary intervention (PCI) with stent, international guidelines endorse the use of direct oral anticoagulants (DOAC) rather than vitamin K antagonists (VKA) and dual antithrombotic therapy (DAT) rather than triple antithrombotic therapy (TAT). The aim of this study was to evaluate contemporary real-world data on antithrombotic regimens and outcome in patients on OAC undergoing PCI with stent. Consecutive patients on OAC undergoing PCI were enrolled in the multicenter, prospective, observational PERSEO registry (NCT03392948). Primary end point was net adverse clinical events (NACE) with VKA versus DOAC, whereas a secondary prespecified end point was NACE with DAT versus TAT both at 1-year follow-up. From February 2018 to February 2022; in total, 1234 consecutive patients were included. The main indication for OAC was atrial fibrillation (86%), and the mean CHA 2 DS 2 VASc and HAS-BLED scores were 4 ± 2 and 3.6 ± 1, respectively. Of the 1228 patients discharged alive, 222 (18%) were on VKA and 1006 (82%) on DOAC ( P < 0.01). DAT was employed in 197 patients whereas TAT in 1028. At follow-up, NACE rate was significantly higher than VKA compared with DOAC (23% vs. 16%, P = 0.013) and confirmed after propensity score adjustment. TAT and DAT did not differ as regards NACE rate (17% vs. 19%, P = 0.864) although, compared with TAT, DAT was associated with less major bleedings (2% vs. 5%, P = 0.014), confirmed after propensity score adjustment. In conclusion, in patients on OAC undergoing PCI, DOAC, compared with VKA, was associated with a significantly lower occurrence of NACE and DAT reduced bleedings compared with TAT.

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Source
http://dx.doi.org/10.1097/FJC.0000000000001607DOI Listing

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