Patterns of antiplatelet therapy during noncardiac surgery in patients with second-generation drug-eluting stents

Choongki Kim, Jung Sun Kim, Hyeongsoo Kim, Sung Gyun Ahn, Sungsoo Cho, Oh Hyun Lee, Jong Kwan Park, Sanghoon Shin, Jae Youn Moon, Hoyoun Won, Yongsung Suh, Jung Rae Cho, Yun Hyeong Cho, Seung Jin Oh, Byoung Kwon Lee, Sung Jin Hong, Dong Ho Shin, Chul Min Ahn, Byeong Keuk Kim, Young Guk KoDonghoon Choi, Myeong Ki Hong, Yangsoo Jang

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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.

Original languageEnglish
Article numbere016218
JournalJournal of the American Heart Association
Volume9
Issue number11
DOIs
Publication statusPublished - 2020 Jun 2

Bibliographical note

Funding Information:
This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (No: HI15C1277), a grant from the National Research Foundation of Korea (NRF) grant, funded by the Korean Government (MSIT) (No. 2017R1A2B2003191), the Ministry of Science & ICT (2017M3A9E9073585) and the Cardiovascular Research Center (Seoul, Korea).

Publisher Copyright:
© 2020, American Heart Association Inc.. All rights reserved.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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