Post-procedural Anticoagulation With Unfractionated Heparin in Acute Coronary Syndrome: Insight from the STOPDAPT-3 Trial.

Autor: Watanabe H; Division of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan., Natsuaki M; Department of Cardiovascular Medicine, Saga University, Saga, Japan., Morimoto T; Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan., Yamamoto K; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan., Obayashi Y; Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan., Nishikawa R; Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan., Hamatani Y; Department of Cardiology, Kyoto Medical Center, Kyoto, Japan., Ando K; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan., Domei T; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan., Suwa S; Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan., Ogita M; Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan., Isawa T; Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan., Takenaka H; Division of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan., Yamamoto T; Division of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan., Ishikawa T; Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan., Hisauchi I; Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan., Wakabayashi K; Department of Cardiology, Showa University Koto Toyosu Hospital, Tokyo, Japan., Onishi Y; Department of Cardiology, Hiratsuka Kyosai Hospital, Hiratsuka, Japan., Hibi K; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan., Kawai K; Division of Cardiology, Chikamori Hospital, Kochi, Japan., Yoshida R; Division of Cardiology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan., Suzuki H; Division of Cardiology, Showa University Fujigaoka Hospital, Yokohama, Japan., Nakazawa G; Department of Cardiology, Kindai University Faculty of Medicine, Osakasayama, Japan., Kusuyama T; Division of Cardiology, Tsukazaki Hospital, Himeji, Japan., Morishima I; Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan., Ono K; Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan., Kimura T; Division of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan. Electronic address: taketaka@kuhp.kyoto-u.ac.jp.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2024 Sep 01; Vol. 226, pp. 83-96. Date of Electronic Publication: 2024 Jul 06.
DOI: 10.1016/j.amjcard.2024.07.002
Abstrakt: The current guidelines for acute coronary syndrome (ACS) discourage the use of anticoagulation after percutaneous coronary intervention (PCI) without specific indications, although the recommendation is not well supported by evidence. In this post hoc analysis of the ShorT and OPtimal Duration of Dual AntiPlatelet Therapy-3 (STOPDAPT-3) trial, 30-day outcomes were compared between the 2 groups with and without post-PCI heparin administration among patients with ACS who did not receive mechanical support devices. The co-primary end points were the bleeding end point, defined as the Bleeding Academic Research Consortium type 3 or 5 bleeding, and the cardiovascular end point, defined as a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischemic stroke. Among 4,088 patients with ACS, 2,339 patients (57.2%) received post-PCI heparin. The proportion of patients receiving post-PCI heparin was higher among those with ST-elevation myocardial infarction compared with others (72.3% and 38.8%, p <0.001), and among patients with intraprocedural adverse angiographic findings compared with those without (67.6% and 47.5%, p <0.001). Post-PCI heparin compared with no post-PCI heparin was associated with a significantly increased risk of the bleeding end point (4.75% and 2.52%, adjusted hazard ratio 1.69, 95% confidence interval 1.15 to 2.46, p = 0.007) and a numerically increased risk of the cardiovascular end point (3.16% and 1.72%, adjusted hazard ratio 1.56, 95% confidence interval 0.98 to 2.46, p = 0.06). Higher hourly dose or total doses of heparin were also associated with higher incidence of both bleeding and cardiovascular events within 30 days. In conclusion, post-PCI anticoagulation with unfractionated heparin was frequently implemented in patients with ACS. Post-PCI heparin use was associated with harm in terms of increased bleeding without the benefit of reducing cardiovascular events. Trial identifier: STOPDAPT-3 ClinicalTrials.gov number, NCT04609111.
Competing Interests: Declaration of competing interest Dr. Watanabe reports lecturer's fees from Abbott Medical Japan during the conduct of the study and from Daiichi Sankyo, Pfizer, Amgen, and Astellas outside the submitted work. Dr. Natsuaki reports honoraria from Abbott Medical Japan, Daiichi Sankyo, Medtronic, Terumo, Japan Lifeline, Asahi Intecc, Bristol-Myers Squibb, Otsuka, Amgen, Sanofi, Takeda, and Bayer. Dr. Morimoto reports lecturer's fees from Abbott, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Japan Lifeline, Pfizer (New York, New York, United States), Tsumura, and UCB; manuscript fee from Pfizer; and advisory board membership for GlaxoSmithKline, Novartis, and Teijin. Dr. Obayashi reports lecturer's fee from Abbott Medical Japan. Dr. Suwa reports personal fees from Abbott Medical Japan and Daiichi Sankyo outside the submitted work. Dr. Ogita reports personal fees from Daiichi Sankyo, Abbott Medical Japan, and Japan Lifeline outside the submitted work. Dr. Suzuki reports grants from Abbott Medical Japan during the conduct of the study. Dr. Morishima reports honoraria from Abbott Medical Japan and Daiichi Sankyo. Dr. Kimura reports grants from Abbott Medical Japan and Boston Scientific and being an advisory board member for Abbott Medical Japan and Terumo Japan. The remaining authors have no competing interests to declare.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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