Optimization of Dual Antiplatelet Therapy in Pakistani Patients Undergoing PCI: A Strategy to Minimize Bleeding Risks and Improve Outcomes

Abstract

Background: Percutaneous Coronary Intervention (PCI) is essential for treating coronary artery disease. The use of Dual Antiplatelet Therapy (DAPT) is crucial to prevent thrombotic complications but presents bleeding risks. This challenge is accentuated by the variability in genetic, demographic, and regional factors, particularly in Pakistan, where there is a high prevalence of cardiovascular diseases. Objective: To optimize DAPT strategies for Pakistani patients undergoing PCI by minimizing bleeding risks while ensuring therapeutic efficacy, aiming to pioneer personalized cardiovascular care. Methods: A retrospective cohort analysis was conducted at Lady Reading Hospital, Peshawar, involving 500 patients who underwent PCI and received DAPT from January 1, 2023, to January 1, 2024. Comprehensive data collection included patient demographics, clinical histories, specifics of PCI procedures, and outcomes of bleeding and thrombotic events, through a detailed review of medical records. Results: The cohort predominantly consisted of males (70%), with an average age of 58 years. Most patients (96%, n=480) were prescribed aspirin and clopidogrel, while a smaller fraction (4%, n=20) received aspirin and ticagrelor. Compliance was high, with 90% adherence. Bleeding occurred in 10% of the cohort (n=50), with major bleeds necessitating hospitalization in 4% (n=20). Thrombotic events were noted in 3% of patients (n=15). Conclusion: The study underscores the importance of personalized DAPT regimens that address individual risks and regional healthcare challenges in Pakistan. Tailored approaches are essential for optimizing treatment efficacy and safety, advocating for advanced, nuanced cardiovascular care practices.