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Dual anti-platelet therapy after drug-eluting coronary stent implantation and risks associated with gastroscopy - a danish registry study

Session Poster session 2

Speaker Hans Erik Botker

Event : ESC Congress 2015

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Coronary Syndromes – Pathophysiology and Mechanisms
  • Session type : Poster Session

Authors : G Egholm (Aarhus,DK), T Thim (Aarhus,DK), M Madsen (Aarhus,DK), HT Soerensen (Aarhus,DK), SE Jensen (Aalborg,DK), LO Jensen (Odense,DK), SD Kristensen (Aarhus,DK), HE Boetker (Aarhus,DK), M Maeng (Aarhus,DK)

Authors:
G. Egholm1 , T. Thim1 , M. Madsen2 , H.T. Soerensen2 , S.E. Jensen3 , L.O. Jensen4 , S.D. Kristensen1 , H.E. Boetker1 , M. Maeng1 , 1Aarhus University Hospital, Department of cardiology - Aarhus - Denmark , 2Aarhus University Hospital, Department of Clinical Epidemiology - Aarhus - Denmark , 3Aalborg University Hospital, Department of cardiology - Aalborg - Denmark , 4Odense University Hospital, Department of cardiology - Odense - Denmark ,

Citation:
European Heart Journal ( 2015 ) 36 ( Abstract Supplement ), 237-238

Background: Dual antiplatelet therapy (DAPT) is recommended for up to 12 month following percutaneous coronary intervention (PCI) with drug-eluting stent implantation (DES) and increases the risk of upper gastrointestinal bleeding and need for gastroscopy. Real-life handling of DAPT in relation to gastroscopy varies and the associated risk of adverse cardiac events and bleeding complications is largely unknown.

Purpose: To quantify 1) the frequency of gastroscopy 2) the incidence of bleeding and cardiac events in relation to gastroscopy and 3) the association between DAPT discontinuation, cardiac events and bleeding within the first 12 months after DES implantation.

Methods: We studied the frequency of gastroscopy within 12 months and numbers of adverse cardiac events and hemostatic intervention in relation to gastroscopy among all- comers treated with DES by cross-linkage of Danish registries. In two nested case-control studies we evaluated hospital charts for the exposure to DAPT. In the adverse cardiac events nested case-control study, patients with cardiac death, myocardial infarction, or stent thrombosis were cases. In the hemostatic intervention study, patients with hemostatic intervention were cases, and patients with gastroscopy including biopsy were controls.

Results: In a cohort of 22.654 patients treated with DES, we identified 1497 patients (6.6%), who underwent gastroscopy within 12 month. Among these, 22 patients (1.5%) suffered from an adverse cardiac event within the first 30 days after the gastroscopy and 93 patients (6.2%) had hemostatic intervention during gastroscopy. The nested-case control studies showed heterogeneity in DAPT prescription; 74% received DAPT during gastroscopy. Discontinuation of both aspirin and the P2Y12-inhibitor was associated with a non-significant increased risk of adverse cardiac event (odds ratio 3.46, 95% confidence interval 0.49–24.7). Periprocedural DAPT was not associated with an increased risk of hemostatic intervention compared to no antiplatelet treatment (odds ratio 1.31, 95% CI 0.37–4.70). No patients experienced bleeding complications as a consequence of gastroscopy with hemostatic intervention or biopsy.

Conclusion: Gastroscopy is a frequent procedure within the first year of stent implantation. While adverse cardiac events were increased with discontinuation of DAPT, an increase was not demonstrated with discontinuation of one antiplatelet drug. Gastroscopy with or without biopsy can safely be performed despite ongoing treatment with DAPT.

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