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Triple Antithrombotic Therapy and Outcomes in Post-PCI Patients Undergoing Non-cardiac Surgery

Javier A Valle1,2, Laura Graham3, Aerin DeRussy3

  • 1VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver, CO, USA. Javier.valle@ucdenver.edu.

World Journal of Surgery
|October 14, 2016
PubMed

Insights

Patients on triple therapy after percutaneous coronary intervention (PCI) face higher risks of major adverse cardiovascular and cerebrovascular events (MACCE) and bleeding during non-cardiac surgery compared to those on dual antiplatelet therapy (DAPT). This highlights a high-risk surgical group needing closer monitoring.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Pharmacology

Background:

  • Triple therapy (anticoagulants plus dual antiplatelet therapy) is used post-percutaneous coronary intervention (PCI) to prevent ischemic events.
  • This therapy increases bleeding risk, which may be amplified in the perioperative period for patients undergoing surgery.
  • Outcomes for post-PCI patients on triple therapy undergoing non-cardiac surgery are not well-established.

Purpose of the Study:

  • To evaluate the perioperative risks associated with triple therapy versus dual antiplatelet therapy (DAPT) in patients undergoing non-cardiac surgery after PCI.
  • To compare rates of major adverse cardiovascular and cerebrovascular events (MACCE) and bleeding between these two therapeutic groups.

Main Methods:

  • Retrospective analysis of Veterans Affairs hospital data (2004-2012).
  • Identified patients undergoing non-cardiac surgery within two years of PCI.
  • Compared perioperative MACCE and bleeding events between patients on triple therapy and DAPT, adjusting for covariates.

Main Results:

  • Of 7811 surgeries, 5.0% were in patients on triple therapy.
  • Triple therapy patients had higher rates of MACCE (11.3% vs. 4.9%) and bleeding (27.4% vs. 13.2%) compared to DAPT patients.
  • Adjusted analysis showed triple therapy was associated with increased MACCE (OR 1.65) and bleeding (OR 1.52).

Conclusions:

  • Post-PCI patients undergoing non-cardiac surgery on triple therapy represent a high-risk population.
  • Surgery in this group is linked to significantly higher rates of MACCE and bleeding, irrespective of other factors.
  • Increased surveillance for adverse perioperative events is warranted for these patients.
Abstract

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