Post-procedural anticoagulation (PPAC) among ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (pPCI) can improve patient survival rates, according to new research published in JACC: Cardiovascular Interventions.[1]
The study’s authors noted that “no major consensus has been reached” when it comes to continuing anticoagulation therapy well after pPCI among this patient population.
“The decision to continue prescribing an anticoagulant can involve a difficult balance between benefit and risk; in real-life clinical practice, it is often a matter of physician’s choice, depending on patient complications and hospital- or clinic-specific prescribing patterns, rather than on any accepted recommendations,” wrote lead author Dr. Yan Yan, of the Center for Coronary Artery Disease at Beijing Anzhen Hospital in China, and colleagues. “The effect of PPAC on reducing mortality and clinically relevant complications, including bleeding, in STEMI patients has been evaluated in randomized clinical trials; however, neither of these studies reached adequate statistical power.”
Yan et al. explored data from the CCC-ACS project, focusing on nearly 35,000 STEMI patients who underwent pPCI from in China from November 2014 to December 2019. Patients were excluded if they presented with an indication for anticoagulation or bleeding complications.
While more than 26,000 patients with a median age of 60.7 years old were prescribed PPAC, the remaining patients — with a median age of 61.8 years old — were not. Both groups were primarily made up of male patients. The most common anticoagulant used among patients in the PPAC group was low-molecular-weight heparin.
Overall, after making certain adjustments, PPAC was associated with a “significantly reduced” risk of in-hospital mortality (0.9% vs. 1.8%) and a “nonsignificant difference in risk” when it came to in-hospital major bleeding events (2.5% vs. 2.2%).
“Whereas the American College of Cardiology/American Heart Association guidelines make no mention of PPAC treatment in STEMI, the European Society of Cardiology guidelines current during the study period stated a preference for no routine use of PPAC unless there is a specific indication for anticoagulation therapy, without reference to level of evidence or classification,” the authors wrote. “In our study, not surprisingly, there was an observed decrease in mortality and bleeding risk over time, representing recent progress in medical therapies.”
The group also noted that updated treatment techniques have caused the risk of acute thrombotic complications to decrease over time, allowing more patients to be discharged “very early” following PCI. The average hospitalization length is still approximately three days, however, with some noted geographic differences.
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