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Influence of Baseline Anemia on Dual Antiplatelet Therapy Cessation and Risk of Adverse Events After Percutaneous
Michela Faggioni1,2, Usman Baber1, Samantha Sartori1
1Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY (M.F., U.B., S. Sartori, J.C., B.E.C., G.D., B.V., S. Sorrentino, A.K., S.F., R.M.).
Insights
Anemia increases risks of major adverse cardiovascular events and bleeding after percutaneous coronary intervention (PCI). Physicians often discontinue dual antiplatelet therapy (DAPT) earlier in anemic patients, a strategy linked to worse outcomes.
Area of Science:
- Cardiology
- Hematology
Background:
- Anemia is a known risk factor for adverse events post-percutaneous coronary intervention (PCI).
- Understanding anemia's impact on dual antiplatelet therapy (DAPT) cessation is crucial for patient outcomes.
Purpose of the Study:
- To investigate how baseline anemia affects DAPT cessation patterns up to two years after PCI.
- To determine the subsequent risk of major adverse cardiovascular events (MACE) and bleeding in anemic patients undergoing PCI.
Main Methods:
- Prospective observational registry (PARIS) of 5018 PCI-treated patients.
- Anemia defined by baseline hemoglobin levels (men <12 g/dL, women <11 g/dL).
- DAPT cessation modes analyzed: physician-recommended discontinuation, interruption (≤14 days), and disruption (bleeding/noncompliance).
Main Results:
- 18% of patients were anemic; they were older with more comorbidities.
- Anemic patients had higher rates of DAPT interruption and disruption.
- Anemia was associated with significantly higher adjusted risks of 2-year MACE and major bleeding.
Conclusions:
- Baseline anemia significantly elevates the adjusted risk of MACE and major bleeding post-PCI.
- Physicians tend to recommend DAPT discontinuation earlier for anemic patients (first year) compared to non-anemic patients (second year).
- DAPT disruption is consistently linked to increased MACE risk, particularly in anemic individuals.
Background:
Anemia is a well-recognized risk factor for both bleeding and ischemic events after percutaneous coronary intervention (PCI). We sought to determine the impact of baseline anemia on dual antiplatelet therapy (DAPT) cessation patterns ≤2 years after PCI and the subsequent risk of clinical adverse events.
Methods And Results:
PARIS (Patterns of Non-Adherence to Dual Anti-Platelet Regimen in Stented Patients) was a prospective multicenter observational registry of PCI-treated patients (n=5018). Anemia was defined as baseline Hb (hemoglobin) <12 g/dL for men and <11 g/dL for women. DAPT cessation modes included physician-recommended discontinuation, temporary interruption (≤14 days), and disruption due to bleeding or noncompliance. The primary end point was 2-year major adverse cardiovascular events (MACE), a composite of cardiac death, myocardial infarction, or target vessel revascularization. We identified 824 (18%) anemic and 4194 (82%) nonanemic patients. Anemic patients were older and had a higher rate of diabetes mellitus, hypertension, and prior PCI. DAPT interruption and disruption were significantly more common in anemic patients throughout 2 years after PCI, whereas physician-recommended discontinuation occurred more often in anemic patients during the first year after PCI and in nonanemic patients during the second year. The 2-year adjusted risks of MACE and Bleeding Academic Research Consortium 3 or 5 bleeding events were significantly higher in anemic patients. Compared with uninterrupted DAPT, disruption, but not interruption and physician-recommended discontinuation, was associated with a higher risk of myocardial infarction in nonanemic patients and a higher risk of both myocardial infarction and MACE in anemic patients. There was no significant interaction between anemia and risk of clinical outcomes associated with each DAPT cessation mode.
Conclusions:
Baseline anemia was associated with a significantly higher adjusted risk of MACE and major bleeding. Physicians more frequently recommend DAPT discontinuation to anemic patients during the first year, and to nonanemic patients during the second year after PCI. DAPT disruption was associated with a higher risk of MACE outcomes.
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