Major bleeding in patients undergoing PCI and triple or dual antithrombotic therapy: a parallel-cohort study

Area of Science:

• Cardiology
• Interventional Cardiology
• Antithrombotic Therapy

Background:

• Combining oral anticoagulants with dual antiplatelet therapy (DAT) after percutaneous coronary intervention with stent implantation (PCI-stenting) presents a high bleeding risk.
• Managing antithrombotic therapy in patients requiring both anticoagulation and dual antiplatelet therapy is complex and controversial.

Purpose of the Study:

• To compare the incidence of major bleeding and major adverse cardiovascular events (MACE) between triple antithrombotic therapy (TT) and dual antiplatelet therapy (DAT) in patients after PCI-stenting.

Main Methods:

• A multicenter retrospective parallel-group study comparing 229 patients on TT (warfarin, aspirin, clopidogrel) with 231 patients on DAT after PCI-stenting.
• Primary endpoint: incidence of major bleeding. Secondary endpoint: occurrence of MACE.
• Follow-up duration was 6 months for the TT group and 7 months for the DAT group.

Main Results:

• Major bleeding occurred in 4.8% of the TT group (9.1% patient/years) versus 0.4% in the DAT group (0.7% patient/years), a statistically significant difference (p = 0.003).
• One fatal bleeding event was reported in the TT group.
• MACE occurred in 5.2% of the TT group and 6.9% of the DAT group, with no significant difference.

Conclusions:

• Triple antithrombotic therapy (TT) in patients after PCI-stenting is associated with a high incidence of major bleeding, even with close monitoring in specialized centers.
• Strategies to mitigate bleeding risk in patients requiring TT after PCI-stenting should be prioritized.
• DAT appears safer regarding bleeding risk, but MACE rates were similar in this study.