Perioperative antiplatelet therapy prevents adverse events in noncardiac surgery patients

A continuation strategy with antiplatelet therapy (APT) appears to reduce net adverse clinical events (NACE) and major adverse cardiovascular events (MACE) at 30 days in patients undergoing noncardiac surgery within a year after percutaneous coronary intervention (PCI), with a similar incidence of major bleeding, relative to an APT discontinuation strategy, a recent study has shown.

This multicentre prospective study was conducted in Korea and included 1,130 patients who underwent noncardiac surgery within 1 year after second-generation drug-eluting stent implantation. A team of investigators performed covariate adjustments using propensity score. The primary endpoint was 30-day NACE, including all-cause death, MACE, and major bleeding events.

Of the patients, 708 (62.7 percent) continued APT during noncardiac surgery. After propensity-score adjustment, the continuation strategy resulted in a reduced incidence of NACE (3.7 percent vs 5.5 percent; adjusted odds ratio [OR], 0.48, 95 percent confidence interval [CI], 0.26‒0.89; p=0.019) and MACE (1.1 percent vs 1.9 percent; adjusted OR, 0.35, 95 percent CI, 0.12‒0.99; p=0.046) compared with APT discontinuation.

On the other hand, no significant between-group difference was observed in the incidence of major bleeding events (1.7 percent vs 2.6 percent; adjusted OR, 0.61, 95 percent CI, 0.25‒1.50; p=0.273).

“This study suggests a possible benefit of APT continuation in noncardiac surgery within 1 year of second-generation drug-eluting stent implantation,” the investigators said.