AUTHOR=von Stein Philipp , Seitz Lukas , Wienemann Hendrik , Hohmann Christopher , Baar Till , Baldus Stephan , Halbach Marcel 

TITLE=Early in-hospital discontinuation of aspirin on the first post-procedural day after percutaneous coronary stent implantation in patients on direct oral anticoagulation

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1265452

DOI=10.3389/fcvm.2023.1265452

ISSN=2297-055X

ABSTRACT=Previous trials investigating antithrombotic therapy with a direct oral anticoagulant (DOAC) and a P2Y12 inhibitor after percutaneous coronary intervention (PCI), termed dual therapy, allowed a short period of triple therapy including a DOAC, a P2Y12 inhibitor, and aspirin.This study aimed to determine whether discontinuation of aspirin on the first post-procedural day is safe or causes ischemic events.Ischemic and bleeding events during hospitalization were investigated retrospectively in all patients treated with dual therapy (DOAC + P2Y12 inhibitor, designated as group 1) or triple therapy (DOAC + P2Y12 inhibitor + aspirin, designated as group 2) from day 1 after PCI at our center.Of 4564 consecutive PCI procedures, 1059 (23.2%) had an indication for OAC. Of these, 322 met the inclusion criteria for group 1 and 62 for group 2. Baseline characteristics, CHA2DS2-VASc and HAS-BLED scores showed no relevant differences between the two groups, and the main indication for DOAC therapy was atrial fibrillation in both groups. Approximately ¼ of patients were treated for acute coronary syndrome. The mean length of post-procedural hospitalization was 2.1±2.5 and 2.2±3.0 days in group 1 and 2, respectively (p=0.305). One patient per group suffered a TIA (p=0.297). There were no other ischemic events and no statistically significant differences in bleeding events. A subgroup analysis of cases hospitalized for ≥2 post-procedural days (group 1: 100 cases, mean 4.4±3.4 days vs. group 2: 25 cases, mean 4.0±4.1 days) confirmed these results.The initiation of dual therapy and thus discontinuation of aspirin on the first postprocedural day appears to be safe with respect to short-term ischemic events in a real-world population. Almost