Prognostic study of extended dual antiplatelet therapy in patients with previous hypertensive cerebral hemorrhage undergoing percutaneous coronary intervention
Qiao Manli
Ma Liping
Su Chonghong
Wen Xue
Abstract：Objective To investigate the risks and benefits of extended dual antiplatelet therapy(DAPT)in patients with previous hypertensive cerebral hemorrhage undergoing percutaneous coronary intervention(PCI).Methods This study was an observational clinical study.A total of 128 patients with a history of hypertensive cerebral hemorrhage who underwent PCI in Beijing Anzhen Hospital,Capital Medical University from January 2005 to December 2014 were enrolled as observation group,and 153 patients with hypertension but no history of cerebral hemorrhage were enrolled as control group.All patients were administered aspirin 100 mg/d and clopidogrel 75 mg/d after PCI,and the follow-up ranged from 12 to 48 months.The efficacy endpoint was major adverse cardiovascular and cerebrovascular events(MACCE),while the safety endpoint were cerebral hemorrhage and major bleeding.The duration of DAPT＞12 months was defined as extended DAPT,and the duration of DAPT 12 months was defined as non-extended DAPT.Univariate and multivariate Cox regression analysis were used to analyze the factors affecting the endpoint events.Results Previous history of hypertensive cerebral hemorrhage(P=0.029)and acute myocardial infarction(P=0.027)were independent risk factors for MACCE in hypertensive patients undergoing PCI,while extended DAPT(hazard ratio=0.351,P＜0.001)was an independent protective factor.In subgroup analysis,extended DAPT increased the risk of major bleeding in PCI patients with previous hypertensive cerebral hemorrhage(hazard ratio=6.650,P=0.036),but did not decrease the risk of MACCE(P=0.349).Extended DAPT did not increase the risk of major bleeding in PCI patients with previous hypertensive(P=0.538),but significantly reduced the risk of MACCE(hazard ratio=0.356,P=0.044).Conclusions Extended DAPT increases the risk of major bleeding in PCI patients with a history of hypertensive cerebral hemorrhage,and DAPT should be controlled within 12 months.Extended DAPT can reduce the risk of MACCE and does not increase the risk of major bleeding in patients with hypertension before PCI.It is recommended to extend the DAPT appropriately.
Keywords：Hypertensive cerebral hemorrhagePercutaneous coronary interventionMajor bleedingDual antiplatelet therapy
Publication Date：2024-06-08
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：5( 801-805 )