Major bleeding was associated with a significant increase in in-hospital mortality, regardless of bleeding site; triple therapy: OAC plus DAPT; Pre-PCI Considerations; less bleeding with Apixaban and without Aspirin (DT) in AF and recent ACS or PCI patients treated with P2Y12 inhibitor; antiplatelet agent considerations...
Hội nghị Tim mạch Miền Trung & Tây Nguyên 2019 12-13/7/2019 Tips for Management of Patients Who Require Oral Anticoagulation for Atrial Fibrillation and Post-PCI Antiplatelet Therapy Dinh Duc Huy, MD, FSCAI Tam Duc Heart Hospital Major bleeding was associated with a significant increase in in-hospital mortality, regardless of bleeding site • 3.3 million PCI procedures (2004–2011 Registry) • Bleeding: most common non-cardiac complication • Antithrombotic therapy that minimizes the risk of bleeding complications therefore might be expected 1.87% in-hospital mortality rate: non-bleeding 5.26% risk difference = 3.39% in-hospital mortality rate: (95% CI: 3.20–3.59) major bleeding P in women Assess the risk of bleeding HAS-BLED score of ≥3 is associated with a high bleeding risk CHA2DS2-VASc HAS-BLED CHA2DS2-VASc criteria Score Congestive heart failure/ left ventricular dysfunction Hypertension Diabetes mellitus Stroke/transient ischaemic attack/TE Age 65–74 years Sex category (i.e female gender) Lip G et al Stroke 2010;41:2731–8; Score Hypertension (SBP >160 mmHg) Age 75 years Vascular disease (prior myocardial infarction, peripheral artery disease, or aortic plaque) HAS-BLED risk criteria 1 Abnormal renal or liver function (1 point each) or Stroke Bleeding Labile INRs Elderly (history or predisposition) (e.g age >65 years) Drugs or alcohol (1 point each) or Pisters R et al Chest 2010;138:1093–100 Considerations During PCI Use radial access preferentially over femoral access for PCI • patients who require post-PCI anticoagulation Use newer generation DES vs BMS • Four weeks of DAPT in HBR patients (LEADERS FREE) • safety confirmed • superior efficacy Adequate clopidogrel and aspirin loading pre-PCI in all patients Continue of aspirin until hospital discharge (even in patients in whom DT is planned on discharge) Đặc điểm bệnh nhân có nguy XH cao • ≥ 75 tuổi • Cần tiếp tục dùng kháng đơng uống sau PCI • Hb in women Assess the risk of