Real clinical experiences of dual versus triple antithrombotic therapy after percutaneous coronary intervention

Area of Science:

• Cardiology
• Interventional Cardiology
• Pharmacology

Background:

• Limited data exist on the clinical benefit of dual antithrombotic therapy (DAT) without aspirin versus triple antithrombotic therapy (TAT) with aspirin in patients requiring oral anticoagulation (OAC) post-percutaneous coronary intervention (PCI).
• Real-world evidence is crucial for understanding antithrombotic strategies in diverse patient populations.

Purpose of the Study:

• To evaluate the impact of aspirin omission on clinical outcomes in patients on OAC therapy treated with drug-eluting stents (DES) or bioresorbable vascular scaffolds (BVS).
• To compare the incidence of major adverse cardiac and cerebrovascular events (MACCE) and bleeding between DAT and TAT regimens.

Main Methods:

• A real-world cohort of 237 patients receiving OAC therapy post-PCI with DES or BVS were analyzed.
• Patients were stratified into two groups: DAT (without aspirin) and TAT (with aspirin).
• Primary endpoint was MACCE within 1 year post-PCI; secondary endpoints included cardiovascular death and bleeding events (BARC/TIMI criteria).

Main Results:

• The rate of MACCE was significantly higher in the DAT group (18%) compared to the TAT group (7.4%) (HR 2.73, P=0.01).
• Multivariable analysis confirmed an independent association between DAT and increased MACCE (HRadj 3.14, P=0.01).
• No significant difference in major bleeding events was observed between the DAT and TAT groups.

Conclusions:

• Dual antithrombotic therapy (DAT) without aspirin was associated with a significantly higher rate of MACCE compared to triple antithrombotic therapy (TAT) in patients on OAC after DES or BVS implantation.
• Further research is warranted to optimize antithrombotic strategies, balancing efficacy and safety in this high-risk patient group.