Perioperative management of oral antiplatelet therapy and clinical outcomes in coronary stent patients undergoing surgery

Roberta Rossini; Giuseppe Musumeci; Davide Capodanno; Corrado Lettieri; Ugo Limbruno; Giuseppe Tarantini; Nicolina Russo; Paolo Calabria; Michele Romano; Ana Inashvili; Vasile Sirbu; Giulio Guagliumi; Orazio Valsecchi; Michele Senni; Antonello Gavazzi; Dominick J. Angiolillo

doi:10.1160/TH14-05-0436

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2015; 113(02): 272-282
DOI: 10.1160/TH14-05-0436

Coagulation and Fibrinolysis

Schattauer GmbH

Perioperative management of oral antiplatelet therapy and clinical outcomes in coronary stent patients undergoing surgery

Results of a multicentre registry

Authors

Roberta Rossini

¹USC Cardiologia, Dipartimento Cardiovascolare, AO Papa Giovanni XXIII, Bergamo, Italy
Giuseppe Musumeci

¹USC Cardiologia, Dipartimento Cardiovascolare, AO Papa Giovanni XXIII, Bergamo, Italy
Davide Capodanno

²Divisione di Cardiologia, Ospedale Ferrarotto, Università di Catania, Italy
Corrado Lettieri

³Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy
Ugo Limbruno

⁴Divisione di Cardiologia, Ospedale della Misericordia, Grosseto, Italy
Giuseppe Tarantini

⁵Dipartimento di Scienze Cardiache, Toraciche e Vascolari, Università di Padova, Italy
Nicolina Russo

¹USC Cardiologia, Dipartimento Cardiovascolare, AO Papa Giovanni XXIII, Bergamo, Italy
Paolo Calabria

⁴Divisione di Cardiologia, Ospedale della Misericordia, Grosseto, Italy
Michele Romano

³Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy
Ana Inashvili

¹USC Cardiologia, Dipartimento Cardiovascolare, AO Papa Giovanni XXIII, Bergamo, Italy
Vasile Sirbu

¹USC Cardiologia, Dipartimento Cardiovascolare, AO Papa Giovanni XXIII, Bergamo, Italy
Giulio Guagliumi

¹USC Cardiologia, Dipartimento Cardiovascolare, AO Papa Giovanni XXIII, Bergamo, Italy
Orazio Valsecchi

¹USC Cardiologia, Dipartimento Cardiovascolare, AO Papa Giovanni XXIII, Bergamo, Italy
Michele Senni

¹USC Cardiologia, Dipartimento Cardiovascolare, AO Papa Giovanni XXIII, Bergamo, Italy
Antonello Gavazzi

⁴Divisione di Cardiologia, Ospedale della Misericordia, Grosseto, Italy
Dominick J. Angiolillo

⁶University of Florida College of Medicine, Jacksonville, Florida, USA

Abstract

Summary

The aim was to investigate the perioperative risk of ischaemic and bleeding events in patients with coronary stents undergoing cardiac and non-cardiac surgery and how these outcomes are affected by the perioperative use of oral antiplatelet therapy. This was a multicentre, retrospective, observational study conducted in patients with coronary stent(s) undergoing cardiac or non-cardiac surgery. The primary efficacy endpoint was the 30-day incidence of major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction (MI) or stroke. The primary safety endpoint was the 30-day incidence of Bleeding Academic Research Consortium (BARC) bleeding ≥ 2. A total of 666 patients were included. Of these, 371 (55.7 %) discontinued their antiplatelet medication(s) (all or partly) before undergoing surgery. At 30 days, patients with perioperative discontinuation of antiplatelet therapy experienced a significantly higher incidence of MACE (7.5 % vs 0.3 %, p < 0.001), cardiac death (2.7 % vs 0.3 %, p=0.027), and MI (4.0 % vs 0 %, p < 0.001). After adjustment, peri-operative antiplatelet discontinuation was the strongest independent predictor of 30-day MACE (odds ratio [OR]=25.8, confidence interval [CI]=3.37–198, p=0.002). Perioperative aspirin (adjusted OR 0.27, 95 % CI 0.11–0.71, p=0.008) was significantly associated with a lower risk of MACE. The overall incidence of BARC ≥ 2 bleeding events at 30-days was significantly higher in patients who discontinued oral antiplatelet therapy (25.6 % vs 13.9 %, p < 0.001). However, after adjustment, antiplatelet discontinuation was not independently associated with BARC ≥ 2 bleeding. In conclusion antiplatelet discontinuation increases the 30-day risk of MACE, in patients with coronary stents undergoing cardiac and non-cardiac surgery, while not offering significant protection from BARC≥ 2 bleeding.

Keywords

Aspirin - antiplatelet therapy - PCI - coronary artery disease - stent - surgery

Full Text

References

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