Evaluation of prolonged antithrombocyte treatment in patients with percutaneous coronary intervention

Introduction and Aim: Current guidelines recommend to use DAPT and PECISE-DAPT , bleeding and ischemic event prediction risk scores to decide daul antiplatelet threapy duration. However scoring systems were not used during clinical practice. Although the proposed scoring systems have been developed using data from large randomized controlled trials, real-life data is limited. The aim of this study was to investigate the duration of dual antiplatelet use according to risk scores in coronary artery patients who were admitted to tertiary health care centre and to evaluate the events that occurred in patients who did not receive appropriate antiplatelet therapy. Methods: The use of dual antiplatelet therapy in patients who underwent percutaneous coronary intervention between August 2017 and May 2019 were evaluated. Three hundred and sixty six patients who met the inclusion and exclusion criteria of 419 patients who completed at least one year after percutaneous coronary intervention were included in the study. DAPT and PRECISE-DAPT scores of all patients were calculated. Properly used dual antiplatelet treatment rates were calculated as the primary endpoint at the end of the first year according to the scores recommendation. Serious bleeding and acute stent thrombosis rates were evaluated bleeding and ischemic event scores and use of appropirate use of antiplatelet therapy. Results: Three hundred and sixty six patients were included in the study. The mean age of the patients was 61 and 42% were female. 81.4% (298) of the patients had acute coronary syndrome (ACS). In 36.1% of the patients, the PRECISE-DAPT score was in high risk group; The DAPT score calculated at the end of the first year was in high-risk group in 62.6% of the patients. 49.2% of the patients had low PREICISE-DAPT and high DAPT scores. According to the guidelines, this group of patients should receive dual antiplatelet therapy for more than one year, however only 15% of the patient population had dual antiplatelet therapy after the first year . Twenty patients (5.5%) had acute stent thrombosis. BARC-3 and above bleeding was detected in 17 (4.6%) patients. 70% (14) of the stent thrombosis events developed at the end of the first year. At the end of the first year, 60% (12) of the patients who developed thrombosis were required to use dual antiplatelet for longer than 1 year (high DAPT, low PRECISE-DAPT score) according to the scores only had acetyl salicylic acid. Of the 17 patients who developed BARC-3 or higher bleeding, 4 had high bleeding risk with low thrombosis risk (high PRECISE-DAPT, low DAPT score), had a bleeding event under dual antiplatelet therapy longer than 6 months even guidelines recommendated less than 6 months use of dual antiplatelet therapy was enough. Conclusion: The dual antiplatelet therapy strategy for patient with coronary artery disease has been discussed and will be discussed for many years. The present study showed that these scores were not used adequately in daily practice, and bleeding and stent thrombosis were high when the scores were not observed. In addition, the study showed that these scores can predict poor outcomes in real-life patients. DAPT and PRECISE-DAPT scores should be used more frequently in daily practice.