Upper gastro-intestinal hemorrhage in patients with coronary stenting & double antiplatelet therapy (DAPT) administration beyond 1 year at Ratchaburi hospital
Keywords:
Double antiplatelet therapy, Acute coronary syndrome, Chronic coronary syndrome, Upper gastrointestinal hemorrhage, Major adverse cardiovascular eventsAbstract
Background: During COVID-19 worldwide pandemic, hundreds of patients whom managed with coronary stenting regard to various indication were scheduled to be followed up & treated by groups of non-cardiologist physicians, many of them were administrated with double anti-platelet therapy (DAPT) strategy, most of them were administrated with DAPT beyond one year, some of them were discontinued DAPT inappropriately due to lack of competency of non-cardiologists to use accepted criteria worldwide (such as DAPT scores which recommended by ACC/AHA) for appropriate DAPT discontinuation in those patients.
Objective: This study purpose is to study whether administration of extended double anti-platelet therapy (DAPT) causes higher incidence of upper gastro-intestinal hemorrhage then standard DAPT in patient with coronary stenting and to calculate duration from drug initiation to events.
Methods: This retrospective cohort study is conducted in patients who receive both standard DAPT & extended DAPT in consecutive fashion and explore incidence of upper gastro-intestinal hemorrhage and measure duration from date of drug initiation to date of first events.
Results: Among 342 patients (average follow up duration 21 months) there were no differences in baseline characteristics (age, sex, co-morbidity, concomitant drugs use, echocardiographic/angiographic data). Incidence of upper gastro-intestinal hemorrhage in patients with standard DAPT was lower than those with extended DAPT (4.8% versus 9.7% respectively) with hazard ratio 0.46 (statistically significant).
Conclusion: Patients with extended DAPT have higher incidence of upper gastro-intestinal hemorrhage than patients who take standard DAPT with statistically significance.
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