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Is routine post-procedural anticoagulation warranted after primary percutaneous coronary intervention in ST-segment
Mahesh V Madhavan1, Philippe Généreux1,2, Ajay J Kirtane1,3
11 Columbia University Medical Center, New York-Presbyterian Hospital, USA.
Insights
Routine post-procedural anticoagulation after percutaneous coronary intervention for ST-elevation myocardial infarction is common but does not improve outcomes. This practice prolonged hospitalization without reducing ischemic or bleeding events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Routine post-procedural anticoagulation (AC) after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is a common practice.
- The clinical utility and safety of this prophylactic approach remain uncertain, necessitating further investigation.
Purpose of the Study:
- To evaluate the effectiveness and safety of routine post-procedural anticoagulation following primary PCI in STEMI patients.
- To determine if post-PCI AC influences key clinical outcomes such as ischemic events, bleeding, and length of hospitalization.
Main Methods:
- Analysis of data from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial.
- Propensity-adjusted multivariable analysis comparing outcomes in patients who received versus did not receive post-PCI AC for routine prophylaxis.
- Assessment of 30-day adverse ischemic events, major bleeding, deep venous thrombosis, and pulmonary embolism.
Main Results:
- Among 2932 STEMI patients undergoing primary PCI, 29.6% received routine post-PCI AC (median 4 days).
- No significant difference in 30-day adverse ischemic or major bleeding events was observed between groups.
- Patients receiving post-PCI AC had a significantly prolonged hospitalization (median 6.0 vs 4.0 days, p<0.0001).
Conclusions:
- Routine post-procedural anticoagulation after primary PCI in STEMI is not associated with improved clinical outcomes.
- The practice was linked to a longer hospital stay without reducing the risk of ischemic events or major bleeding.
- Post-PCI AC for routine prophylaxis may not be beneficial in STEMI patients suitable for early ambulation.
Aim:
Post-procedural anticoagulation (AC) for routine prophylaxis may be administered after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI), but the risks and benefits of this practice are uncertain. We therefore sought to assess the utility of routine post-procedural AC after primary PCI.
Methods And Results:
Patients undergoing primary PCI in the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial were grouped according to whether they received post-PCI AC for routine prophylaxis. Outcomes were assessed using propensity-adjusted multivariable analysis. Among 2932 patients in whom primary PCI for STEMI was performed, 869 (29.6%) received post-PCI AC for routine prophylaxis (median duration four days) and 2063 (70.4%) received no post-PCI AC. Time from PCI to ambulation was similar in both groups (median 0.9 vs 1.0 days, p=0.40), although hospitalization was prolonged in patients receiving AC for routine prophylaxis (median 6.0 vs 4.0 days, p<0.0001). After propensity-adjustment, patients who received and did not receive AC for routine prophylaxis after PCI experienced similar rates of 30-day adverse ischemic and major bleeding events. Deep venous thrombosis or pulmonary emboli developed rarely (0.3%) within 30 days, and were not significantly reduced by use of post-PCI AC for routine prophylaxis.
Conclusions:
In this large-scale prospective study, use of post-procedural AC for routine prophylaxis was relatively common, and was not associated with improved clinical outcomes, although the duration of hospitalization was prolonged. These data suggest that post-PCI AC for routine prophylaxis may not provide benefit after successful primary PCI in patients in whom early ambulation is likely.
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