Abstract 14077: Anticoagulation Following Percutaneous Coronary Intervention in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Abstract

Introduction: To maximize reperfusion and thrombus breakdown, anticoagulation therapy may be continued after percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndrome (ACS). However, limited evidence exists to support this practice. Methods: An electronic search was conducted using MEDLINE and EMBASE databases from inception to March 19th, 2023. Eligible studies comparing 30-day outcomes of post-procedural anticoagulation (PPAC) with no PPAC after PCI in patients with ACS were screened for inclusion. The primary outcome was 30-day mortality. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effect model. Results: Total 6 studies (3 observational, 3 post-hoc analyses of randomized controlled trials) with 61,901 patients (PPAC=38,900, no PPAC=23,001) were selected. There were no significant differences in all-cause mortality (RR 0.79 [0.52-1.19], P=0.26), cardiac mortality (RR 0.69 [0.43-1.11], P=0.13), myocardial infarction (RR 0.86 [0.61-1.21] P=0.39), stroke (RR 1.18 [0.87-1.59], P=0.29), and major bleeding (RR 0.91 [0.65-1.27], P=0.58) between PPAC and no PPAC groups. However, PPAC was associated with a higher rate of stent thrombosis at 30 days (RR 1.34 [1.04-1.73], P=0.02). Conclusions: Overall, PPAC following PCI for ACS did not improve survival or cardiovascular morbidity. However, there was a slightly higher incidence of stent thrombosis in the PPAC cohort. Further randomized studies are necessary to confirm these findings.