| Title: |
Early oral anticoagulation monotherapy after PCI: insights from the POEM trial |
| Authors: |
Pivato, C A; Mincione, G; Gramss, L; Pacchioni, A; Piccolo, R; Musto, C; Sardella, G; Indolfi, C; Paradies, V; Reimers, B; Condorelli, G; Testa, L; Briguori, C; Stefanini, G |
| Source: |
European Heart Journal Supplements ; volume 28, issue Supplement_3 ; ISSN 1520-765X 1554-2815 |
| Publisher Information: |
Oxford University Press (OUP) |
| Publication Year: |
2026 |
| Description: |
Background/Introduction In high-bleeding-risk (HBR) patients undergoing percutaneous coronary intervention (PCI), shortening dual antiplatelet therapy (DAPT) is essential, but the optimal approach in those requiring oral anticoagulation (OAC) is uncertain. Purpose To evaluate a 1-month dual antithrombotic regimen in HBR patients with and without OAC indication in a prespecified sub-analysis of the POEM trial. Methods POEM enrolled HBR patients treated with a bioresorbable polymer everolimus-eluting stent. Patients were stratified by OAC indication: the non-OAC group (n=281) received 1-month DAPT followed by single antiplatelet therapy; the OAC group (n=158) received 1-month OAC plus a P2Y12 inhibitor followed by OAC monotherapy. Time-to-event outcomes were analyzed using the log-rank test, and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox regression models. The primary analysis was conducted according to the intention-to-treat principle. A per-protocol analysis, excluding patients with DAPT duration >1 month, was performed as a sensitivity analysis. Results At 1-year, the primary endpoint, a composite of cardiac death, myocardial infarction, or definite/probable stent thrombosis, occurred in 6.1% of the non-OAC group versus 2.6% of the OAC group (HR 0.41, 95% CI 0.14–1.22; p=0.097). Secondary ischemic outcomes were similar. Major bleeding (BARC type 3–5) was infrequent (2.6% vs. 1.3%; p=0.369). The per-protocol analysis showed consistent results. Conclusion In HBR patients after PCI, transition to OAC monotherapy at 1 month was associated with low ischemic and bleeding risks, comparable to single antiplatelet therapy. These findings support early OAC monotherapy as a feasible strategy deserving randomized investigation.Study design and main findingFor image description, please refer to the figure legend and surrounding text. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1093/eurheartjsupp/suag056.164 |
| Availability: |
https://doi.org/10.1093/eurheartjsupp/suag056.164; https://academic.oup.com/eurheartjsupp/article-pdf/28/Supplement_3/suag056.164/67654518/suag056.164.pdf |
| Rights: |
https://academic.oup.com/pages/standard-publication-reuse-rights |
| Accession Number: |
edsbas.307165BA |
| Database: |
BASE |