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Patterns of Antiplatelet Therapy During Noncardiac Surgery in Patients With Second-Generation Drug-Eluting Stents

Title
Patterns of Antiplatelet Therapy During Noncardiac Surgery in Patients With Second-Generation Drug-Eluting Stents
Authors
Kim C.Kim J.-S.Kim H.Ahn S.G.Cho S.Lee O.-H.Park J.-K.Shin S.Suh Y.Cho J.R.Cho Y.-H.Oh S.-J.Lee B.-K.Hong S.-J.Shin D.-H.Ahn C.-M.Kim B.-K.Ko Y.-G.Choi D.Hong M.-K.Jang Y.Moon J.Y.Won H.
Ewha Authors
신상훈
Issue Date
2020
Journal Title
Journal of the American Heart Association
ISSN
2047-9980JCR Link
Citation
Journal of the American Heart Association vol. 9, no. 11, pp. e016218
Keywords
antiplatelet agentstentsurgery
Publisher
NLM (Medline)
Indexed
SCIE; SCOPUS scopus
Document Type
Article
Abstract
Background Continuing antiplatelet therapy (APT) has been generally recommended during noncardiac surgery, but it is uncertain if preoperative discontinuation of APT has been avoided or harmful in patients with second-generation drug-eluting coronary stents. Methods and Results Patients undergoing noncardiac surgery after second-generation drug-eluting coronary stent implantation were assessed in a multicenter cohort in Korea. Net adverse clinical events within 30 days postoperatively, defined as all-cause death, major adverse cardiac events, and major bleeding, were evaluated. Of 3582 eligible patients, 49% patients discontinued APT during noncardiac surgery. The incidence of net adverse clinical events was comparable between patients with continuation versus discontinuation (4.1% versus 3.4%; P=0.257) of APT during noncardiac surgery. Perioperative discontinuation of APT did not impact on net adverse clinical events (adjusted hazard ratio [HR], 1.00; 95% CI, 0.69-1.44; P=0.995). In subgroup analysis, patients undergoing intra-abdominal surgery were exposed to less risk of major bleeding by discontinuing APT (adjusted HR, 0.26; 95% CI, 0.08-0.91; P=0.035). Prolonged discontinuation of APT for ≥9 days was associated with higher risk of a major adverse cardiac event compared with continuing APT (adjusted HR, 3.38; 95% CI, 1.36-8.38; P=0.009). Conclusions APT was discontinued preoperatively in almost half of patients with second-generation drug-eluting coronary stents. Our explorative analysis showed that there was no significant impact of discontinuing APT on the risk of perioperative adverse events except that discontinuing APT may be associated with decreased hemorrhagic risk in patients undergoing intra-abdominal surgery. Registration URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT03908463.
DOI
10.1161/JAHA.119.016218
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의료원 > 의료원 > Journal papers
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