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Causes, Timing, and Impact of Dual Antiplatelet Therapy Interruption for Surgery (from the Patterns of Non-adherence to Anti-platelet Regimens In Stented Patients Registry).

TitleCauses, Timing, and Impact of Dual Antiplatelet Therapy Interruption for Surgery (from the Patterns of Non-adherence to Anti-platelet Regimens In Stented Patients Registry).
Publication TypeJournal Article
Year of Publication2017
AuthorsSchoos, M., Chandrasekhar J., Baber U., Bhasin A., Sartori S., Aquino M., Vogel B., Farhan S., Sorrentino S., Kini A., Kruckoff M., Moliterno D., Henry T. D., Weisz G., C Gibson M., Iakovou I., Colombo A., P Steg G., Witzenbichler B., Chieffo A., Cohen D., Stuckey T., Ariti C., Dangas G., Pocock S., & Mehran R.
JournalAm J Cardiol
Volume120
Issue6
Pagination904-910
Date Published2017 Sep 15
ISSN1879-1913
KeywordsAged, Aspirin, Coronary Artery Disease, Drug Therapy, Combination, Female, Follow-Up Studies, Humans, Male, Medication Adherence, Middle Aged, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Preoperative Care, Prospective Studies, Registries, Retrospective Studies, Ticlopidine, Time Factors, Withholding Treatment
Abstract

Temporary interruption of dual antiplatelet therapy (DAPT) is not infrequently required in patients undergoing percutaneous coronary intervention (PCI). We sought to describe the procedures and outcomes associated with DAPT interruption in patients treated with DAPT following successful PCI from the Patterns of non-adherence to anti-platelet regimens in stented patients registry (n = 5018). DAPT interruption was prespecified as physician recommended cessation for <14 days. Of the study cohort, 490 patients (9.8%) experienced 594 DAPT interruptions over 2 years following PCI. Only 1 antiplatelet agent was interrupted in 57.2% cases and interruption was frequently recommended by noncardiologists (51.3%). Where type of surgery was reported, majority of DAPT interruptions occurred for minor surgery (68.4% vs 31.6%) and a similar cessation pattern of single versus dual antiplatelet cessation was observed regardless of minor or major surgery. Subsequent to DAPT interruption, 12 patients (2.4%) experienced 1 thrombotic event each, of which 5 (1.0%) occurred during the interruption period. All events occurred in patients who either stopped both agents (8 of 12) or clopidogrel-only (4 of 12), with no events occurring due to aspirin cessation alone. In conclusion, in the Patterns of Non-adherence to Anti-platelet Regiments in Stented Patients registry, 1 in 10 patients were recommended DAPT interruption for surgery within 2 years of PCI. Interruption was more common for a single agent rather than both antiplatelet agents regardless of severity of surgery, and was frequently recommended by noncardiologists. Only 1% of patients with DAPT interruption experienced a subsequent thrombotic event during the interruption period, which mainly occurred in patients stopping both antiplatelet agents.

DOI10.1016/j.amjcard.2017.06.016
Alternate JournalAm. J. Cardiol.
PubMed ID28778417

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