Thromb Haemost 2016; 116(01): 172-180
DOI: 10.1160/TH15-12-0954
Atherosclerosis and Ischaemic Disease
Schattauer GmbH

Dual anti-platelet therapy after coronary drug-eluting stent implantation and surgery-associated major adverse events

Gro Egholm
1   Department of Cardiology, Aarhus Universitetshospital, Aarhus, Denmark
2   Department of Clinical Epidemiology, Aarhus Universitetshospital, Aarhus, Denmark
,
Troels Thim
1   Department of Cardiology, Aarhus Universitetshospital, Aarhus, Denmark
,
Kevin Kris Olesen
1   Department of Cardiology, Aarhus Universitetshospital, Aarhus, Denmark
,
Morten Madsen
2   Department of Clinical Epidemiology, Aarhus Universitetshospital, Aarhus, Denmark
,
Henrik Toft Sorensen
2   Department of Clinical Epidemiology, Aarhus Universitetshospital, Aarhus, Denmark
,
Svend Eggert Jensen
1   Department of Cardiology, Aarhus Universitetshospital, Aarhus, Denmark
,
Lisette Okkels Jensen
1   Department of Cardiology, Aarhus Universitetshospital, Aarhus, Denmark
,
Hans Erik Botker
1   Department of Cardiology, Aarhus Universitetshospital, Aarhus, Denmark
,
Steen Dalby Kristensen
1   Department of Cardiology, Aarhus Universitetshospital, Aarhus, Denmark
,
Michael Maeng
1   Department of Cardiology, Aarhus Universitetshospital, Aarhus, Denmark
› Author Affiliations
Further Information

Publication History

Received: 14 December 2015

Accepted after major revision: 15 March 2016

Publication Date:
27 November 2017 (online)

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Summary

Surgery may necessitate interruption of dual antiplatelet therapy (DAPT) within the first year after coronary drug-eluting stent (DES) implantation. We conducted a population-based cohort study to assess the rate of surgery within the first year after DES implantation, surgery-associated major adverse cardiac events (MACE), reoperation for bleeding within 30 days after surgery, and two nested case-control analyses to explore any association between preoperative antiplatelet therapy, MACE, and reoperation for bleeding. In the cohort of 22,654 patients treated with DES, 1,944 patients (8.6 %) underwent moderate- to high-risk surgery within 12 months. Of these, 62 (3.2 %) experienced MACE and 54 (2.8 %) needed reoperation for bleeding within 30 days. In the nested case-control analyses of 458 cases and controls, where 70 % (n=324) had a first generation DES, absence of preoperative antiplatelet therapy was associated with an increased MACE rate (OR 2.36, 95 % CI 1.02–5.48) compared to single antiplatelet therapy (SAPT) or DAPT. Preoperative SAPT versus DAPT showed no difference in MACE rates (OR 0.85, 95 % CI 0.30–2.40). Surgery within the first month was associated with increased MACE rate (OR 4.67, 95 % CI 2.22–9.83) compared to surgery 2–12 months after DES implantation. Absence of preoperative antiplatelet therapy did not reduce reoperation for bleeding as compared to patients on SAPT or DAPT (OR 1.32, 95 % CI 0.56–3.12). In conclusion, absence of preoperative antiplatelet therapy and surgery within the first month after DES implantation were associated with increased MACE rates.