Incidence and impact of antiplatelet therapy cessation among very older patients with stable coronary artery disease

被引:2
作者
Zou, Xiao [1 ]
Wang, Liang [1 ]
Sun, Sha-Sha [1 ]
Hu, Yi-Xin [2 ]
Liu, Hong-Wei [1 ]
Wang, Hao [1 ]
Cao, Jian [1 ]
Liu, Hong-Bin [1 ]
Fan, Li [1 ]
机构
[1] Chinese Peoples Liberat Army Gen Hosp, Med Ctr 2, Natl Clin Res Ctr Geriatr Dis, Cardiol Dept, Beijing, Peoples R China
[2] Chinese Peoples Liberat Army Gen Hosp, Med Ctr 2, Forth Healthcare Dept, Beijing, Peoples R China
关键词
stable coronary artery disease; antiplatelet therapy; MACE; bleeding; mortality; MYOCARDIAL-INFARCTION; MEDICATION ADHERENCE; ASPIRIN; RISK; METAANALYSIS; PREVENTION; GUIDELINES; MANAGEMENT; WITHDRAWAL; TRIAL;
D O I
10.3389/fphar.2023.1183839
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Objectives: Long-term use of evidence-based antiplatelet therapy is recommended for management of stable coronary artery disease (SCAD). However, non-adherence to antiplatelet drugs is common in older patients. This study aimed to evaluate the incidence and impact of antiplatelet therapy cessation on clinical outcomes of older patients with SCAD. Methods: A total of 351 consecutive eligible very older patients (=80 years) with SCAD from the PLA General Hospital were included. Baseline demographics, clinical characteristics, and clinical outcomes were collected during follow-up. Patients were divided into cessation group and standard group based on whether discontinuing of antiplatelet drugs. The primary outcome was major adverse cardiovascular events (MACE) and secondary outcomes were minor bleeding and all-cause mortality. Results: A total of 351 participants, with a mean age of 91.76 +/- 5.01 years old (range 80-106 years) were included in statistical analysis. The antiplatelet drug cessation rate was 60.1%. There were 211 patients in cessation group and 140 patients in standard group. During a median follow-up of 98.6months, the primary outcome of MACE occurred in 155 patients (73.5%) in the cessation group and 84 patients (60.0%) in the standard group (HR = 1.476, 95% CI:1.124-1.938, p = 0.005). Cessation of antiplatelet drugs increased the rates of angina (HR = 1.724, 95% CI:1.211-2.453, p = 0.002) and non-fatalMI (HR = 1.569, 95% CI:1.093-2.251, p = 0.014). The secondary outcomes of minor bleeding and all-cause mortality were similar between the two groups. Conclusion: Among very older patients with SCAD, antiplatelet therapy cessation significantly increased the risk of MACE, and continuous antiplatelet drug therapy didn't increase the risk of minor bleeding.
引用
收藏
页数:7
相关论文
共 22 条
[1]   Incidence, Patterns, and Impact of Dual Antiplatelet Therapy Cessation Among Patients With and Without Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention Results From the PARIS Registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) [J].
Baber, Usman ;
Li, Shawn X. ;
Pinnelas, Rebecca ;
Pocock, Stuart J. ;
Krucoff, Mitchell W. ;
Ariti, Cono ;
Gibson, C. Michael ;
Steg, Philippe Gabriel ;
Weisz, Giora ;
Witzenbichler, Bernhard ;
Henry, Timothy D. ;
Kini, Annapoorna S. ;
Stuckey, Thomas ;
Cohen, David J. ;
Iakovou, Ioannis ;
Dangas, George ;
Aquino, Melissa B. ;
Sartori, Samantha ;
Chieffo, Alaide ;
Moliterno, David J. ;
Colombo, Antonio ;
Mehran, Roxana .
CIRCULATION-CARDIOVASCULAR INTERVENTIONS, 2018, 11 (03)
[2]  
Baigent C, 2002, BMJ-BRIT MED J, V324, P71, DOI 10.1136/bmj.324.7329.71
[3]   A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50 279 patients at risk for coronary artery disease [J].
Biondi-Zoccai, Giuseppe G. L. ;
Lotrionte, Marzia ;
Agostoni, Pierfrancesco ;
Abbate, Antonio ;
Fusaro, Massimiliano ;
Burzotta, Francesco ;
Testa, Luca ;
Sheiban, Imad ;
Sangiorgi, Giuseppe .
EUROPEAN HEART JOURNAL, 2006, 27 (22) :2667-2674
[4]   Medication adherence: A call for action [J].
Bosworth, Hayden B. ;
Granger, Bradi B. ;
Mendys, Phil ;
Brindis, Ralph ;
Burkholder, Rebecca ;
Czajkowski, Susan M. ;
Daniel, Jodi G. ;
Ekman, Inger ;
Ho, Michael ;
Johnson, Mimi ;
Kimmel, Stephen E. ;
Liu, Larry Z. ;
Musaus, John ;
Shrank, William H. ;
Buono, Elizabeth Whalley ;
Weiss, Karen ;
Granger, Christopher B. .
AMERICAN HEART JOURNAL, 2011, 162 (03) :412-424
[5]   Impact of prior use or recent withdrawal of oral antiplatelet agents on acute coronary syndromes [J].
Collet, JP ;
Montalescot, G ;
Blanchet, B ;
Tanguy, ML ;
Golmard, JL ;
Choussat, R ;
Beygui, F ;
Payot, L ;
Vignolles, N ;
Metzger, JP ;
Thomas, D .
CIRCULATION, 2004, 110 (16) :2361-2367
[6]   Discontinuation of Low-Dose Aspirin Therapy After Peptic Ulcer Bleeding Increases Risk of Death and Acute Cardiovascular Events [J].
Derogar, Maryam ;
Sandblom, Gabriel ;
Lundell, Lars ;
Orsini, Nicola ;
Bottai, Matteo ;
Lu, Yunxia ;
Sadr-Azodi, Omid .
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, 2013, 11 (01) :38-42
[7]   Influence of Baseline Anemia on Dual Antiplatelet Therapy Cessation and Risk of Adverse Events After Percutaneous Coronary Intervention Insights From the PARIS Registry [J].
Faggioni, Michela ;
Baber, Usman ;
Sartori, Samantha ;
Chandrasekhar, Jaya ;
Cohen, David J. ;
Henry, Timothy D. ;
Claessen, Bimmer E. ;
Dangas, George D. ;
Gibson, C. Michael ;
Krucoff, Mitchell W. ;
Vogel, Birgit ;
Moliterno, David J. ;
Sorrentino, Sabato ;
Colombo, Antonio ;
Chieffo, Alaide ;
Kini, Annapoorna ;
Farhan, Serdar ;
Ariti, Cono ;
Witzenbichler, Bernard ;
Weisz, Giora ;
Steg, Philippe Gabriel ;
Pocock, Stuart ;
Mehran, Roxana .
CIRCULATION-CARDIOVASCULAR INTERVENTIONS, 2019, 12 (04)
[8]   Coronary syndromes following aspirin withdrawal - A special risk for late stent thrombosis [J].
Ferrari, E ;
Benhamou, M ;
Cerboni, P ;
Marcel, B .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2005, 45 (03) :456-459
[9]   2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons [J].
Fihn, Stephan D. ;
Gardin, Julius M. ;
Abrams, Jonathan ;
Berra, Kathleen ;
Blankenship, James C. ;
Dallas, Apostolos P. ;
Douglas, Pamela S. ;
Foody, JoAnne M. ;
Gerber, Thomas C. ;
Hinderliter, Alan L. ;
King, Spencer B., III ;
Kligfield, Paul D. ;
Krumholz, Harlan M. ;
Kwong, Raymond Y. K. ;
Lim, Michael J. ;
Linderbaum, Jane A. ;
Mack, Michael J. ;
Munger, Mark A. ;
Prager, Richard L. ;
Sabik, Joseph F. ;
Shaw, Leslee J. ;
Sikkema, Joanna D. ;
Smith, Craig R., Jr. ;
Smith, Sidney C. ;
Spertus, John A. ;
Williams, Sankey V. .
CIRCULATION, 2012, 126 (25) :E354-U191
[10]   A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE) [J].
Gent, M ;
Beaumont, D ;
Blanchard, J ;
Bousser, MG ;
Coffman, J ;
Easton, JD ;
Hampton, JR ;
Harker, LA ;
Janzon, L ;
Kusmierek, JJE ;
Panak, E ;
Roberts, RS ;
Shannon, JS ;
Sicurella, J ;
Tognoni, G ;
Topol, EJ ;
Verstraete, M ;
Warlow, C .
LANCET, 1996, 348 (9038) :1329-1339