Unexpected Discontinuation of Dual Antiplatelet Therapy within 14 Days after Percutaneous Coronary Intervention: A Single-center Case Series

Objectives: To provide a descriptive case-series of patients who unexpectedly discontinued dual antiplatelet therapy (DAPT) within 14 days after percutaneous coronary intervention (PCI) (group A), and those who had taken measures for bleeding risk reduction before PCI (group B).
Study Design: Case study.
Place and Duration of Study: Cardiovascular Center, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, between 2009 and 2011.
Methods and Results: We retrospectively reviewed 346 patientsundergoing PCI in our hospital. In group A (n=12, 3.46%), 10 patients underwent emergent PCI including 3 cases of cardiopulmonary arrest. The procedures were 8 cases of bare metal stent implantation, 2 cases of drug-eluting stent (DES) implantation, and 2 cases of balloon angioplasty. The reasons for discontinuation included 6 cases of bleeding, out of which 4 cases involved pulmonary bleeding, and 3 involved sequential operation. The mean time of DAPT cessation was 3.3 days. The mortality rate of patients with pulmonary bleeding was 75%. In group B (n=9, 2.60%), 4 cases were emergent PCI and 5 were scheduled. Reasons for taking bleeding risk reduction measures included past history of bleeding, cancer, and poor adherence. The methods of bleeding risk reduction included avoidance of DES and the use of cilostazol, which resulted in noserious bleeding or thrombosis occurring.
Conclusions: A descriptive case-series of patients who unexpectedly discontinued DAPT within 14 days and those who had taken bleeding risk reduction measures before PCI was provided. Our results imply that careful planning regarding the antiplatelet therapy and risk assessment for bleeding, including pulmonary bleeding, are warranted for patients undergoing PCI.