Antithrombotic therapy in high-risk patients after percutaneous coronary intervention; study design, cohort profile and incidence of adverse events

R.H. Olie*, P.E.J. van der Meijden, M.J.A. Vries, L. Veenstra, A.W.J. van't Hof, J.M. ten Berg, Y.M.C. Henskens, H. ten Cate

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Web of Science)

Abstract

Background Patients with multiple clinical risk factors are a complex group in whom both bleeding and recurrent ischaemic events often occur during treatment with dual/triple antithrombotic therapy after percutaneous coronary intervention. Decisions on optimal antithrombotic treatment in these patients are challenging and not supported by clear guideline recommendations. A prospective observational cohort study was set up to evaluate patient-related factors, platelet reactivity, genetics, and a broad spectrum of biomarkers in predicting adverse events in these high-risk patients. Aim of the current paper is to present the study design, with a detailed description of the cohort as a whole, and evaluation of bleeding and ischaemic outcomes during follow-up, thereby facilitating future research questions focusing on specific data provided by the cohort. Methods We included patients with >= 3 predefined risk factors who were treated with dual/triple antithrombotic therapy following PCI. We performed a wide range of haemostatic tests and collected all ischaemic and bleeding events during 6-12 months follow-up. Results We included 524 high-risk patients who underwent PCI within the previous 1-2 months. All patients used a P2Y12 inhibitor (clopidogrel n = 388, prasugrel n = 61, ticagrelor n = 75) in combination with aspirin (n = 397) and/or anticoagulants (n = 160). Bleeding events were reported by 254 patients (48.5%), necessitating intervention or hospital admission in 92 patients (17.5%). Major adverse cardiovascular events (myocardial infarction, stroke, death) occurred in 69 patients (13.2%). Conclusion The high risk for both bleeding and ischaemic events in this cohort of patients with multiple clinical risk factors illustrates the challenges that the cardiologist faces to make a balanced decision on the optimal treatment strategy. This cohort will serve to answer several future research questions about the optimal management of these patients on dual/triple antithrombotic therapy, and the possible value of a wide range of laboratory tests to guide these decisions.
Original languageEnglish
Pages (from-to)525-535
Number of pages11
JournalNetherlands Heart Journal
Volume29
Issue number10
Early online date1 Sep 2021
DOIs
Publication statusPublished - Oct 2021

Keywords

  • Anticoagulation
  • Antiplatelet therapy
  • Antithrombotic treatment
  • Percutaneous coronary intervention
  • Coronary artery disease
  • Bleeding
  • DUAL ANTIPLATELET THERAPY
  • TREATMENT PLATELET REACTIVITY
  • ARTERY-DISEASE
  • BLEEDING SCORE
  • CLOPIDOGREL
  • DEFINITION
  • VALIDATION
  • PRASUGREL
  • CONSENSUS
  • IMPLANTATION

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