title: Perioperative management of oral antiplatelet therapy and clinical outcomes in coronary stent patients undergoing surgery. Results of a multicentre registry.
abstract: The aim was to investigate the perioperative risk of ischaemic and bleeding events in patients with coronary stents undergoing cardiac and non-cardiac surgery and how these outcomes are affected by the perioperative use of oral antiplatelet therapy. This was a multicentre, retrospective, observational study conducted in patients with coronary stent(s) undergoing cardiac or non-cardiac surgery. The primary efficacy endpoint was the 30-day incidence of major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction (MI) or stroke. The primary safety endpoint was the 30-day incidence of Bleeding Academic Research Consortium (BARC) bleeding ≥ 2. A total of 666 patients were included. Of these, 371 (55.7 %) discontinued their antiplatelet medication(s) (all or partly) before undergoing surgery. At 30 days, patients with perioperative discontinuation of antiplatelet therapy experienced a significantly higher incidence of MACE (7.5 % vs 0.3 %, p< 0.001), cardiac death (2.7 % vs 0.3 %, p=0.027), and MI (4.0 % vs 0 %, p< 0.001). After adjustment, peri-operative antiplatelet discontinuation was the strongest independent predictor of 30-day MACE (odds ratio [OR]=25.8, confidence interval [CI]=3.37-198, p=0.002). Perioperative aspirin (adjusted OR 0.27, 95 % CI 0.11-0.71, p=0.008) was significantly associated with a lower risk of MACE. The overall incidence of BARC ≥ 2 bleeding events at 30-days was significantly higher in patients who discontinued oral antiplatelet therapy (25.6 % vs 13.9 %, p< 0.001). However, after adjustment, antiplatelet discontinuation was not independently associated with BARC ≥ 2 bleeding. In conclusion antiplatelet discontinuation increases the 30-day risk of MACE, in patients with coronary stents undergoing cardiac and non-cardiac surgery, while not offering significant protection from BARC≥ 2 bleeding.
authors.affiliation: Roberta Rossini, MD, PhD, Cardiovascular Department, A. O. PAPA GIOVANNI XXIII, Piazza OMS, 1, 24127 Bergamo, Italy, Tel.: +39 035 2673446, E-mail: roberta.rossini2@gmail.com.
authors.forename: Roberta
authors.initials: R
authors.lastname: Rossini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.forename: Corrado
authors.initials: C
authors.lastname: Lettieri
authors.forename: Ugo
authors.initials: U
authors.lastname: Limbruno
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Nicolina
authors.initials: N
authors.lastname: Russo
authors.forename: Paolo
authors.initials: P
authors.lastname: Calabria
authors.forename: Michele
authors.initials: M
authors.lastname: Romano
authors.forename: Ana
authors.initials: A
authors.lastname: Inashvili
authors.forename: Vasile
authors.initials: V
authors.lastname: Sirbu
authors.forename: Giulio
authors.initials: G
authors.lastname: Guagliumi
authors.forename: Orazio
authors.initials: O
authors.lastname: Valsecchi
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
authors.forename: Antonello
authors.initials: A
authors.lastname: Gavazzi
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
mesh_terms: D000284:Administration, Oral; D000368:Aged; D060050:Angina, Stable / Q000628:therapy; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D015992:Body Mass Index; D000077144:Clopidogrel; D054855:Drug-Eluting Stents; D005260:Female; D006470:Hemorrhage / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000628:therapy; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000379:methods; D059035:Perioperative Period; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D015995:Prevalence; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Aspirin; PCI; antiplatelet therapy; coronary artery disease; stent; surgery