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Dual Antiplatelet Therapy Does Not Affect Target Vessel Occlusion Or Bleeding Complications Following F/bevar
Blake E. Murphy, MD, Gerald Anderson, BS, Matthew P. Sweet, MD, Sara L. Zettervall, MD MPH.
University of Washington, Seattle, WA, USA.
Objective: Delphi consensus recommends utilization of dual antiplatelet therapy (DAPT) following fenestrated and branched aortic repair (F/BEVAR) for target vessel (TV) patency. Limited data supports this recommendation and impact on bleeding events and treatment duration is unknown. This study assesses TV occlusion and bleeding complications based on antiplatelet/anticoagulation (AC) use following F/BEVAR.
Methods: Patients who underwent F/BEVAR for thoracoabdominal aortic aneurysm at a single institution from 2012-2024 were assessed. Discharge regimens were maintained for 3-months and long-term regimens recorded: single antiplatelet therapy (SAPT), DAPT, and AC+SAPT. TV occlusion and bleeding events were compared based on discharge medications and long-term regimens and time-event analyses performed.
Results: 235 patients were included; 53% were discharged on SAPT, 28% on DAPT, and 19% on AC+SAPT. Overall, 35 TV occlusions (3.8%) occurred: 31 branches (6.1%), 4 fenestrations (1.0%); 29 renal (6.4%), and 5 mesenteric targets (1.1%) during follow-up. TV occlusion did not differ by discharge or long-term medication regimen (Table I). In time-to-event analysis, TV occlusions were also similar (1 year: 3.4% vs. 2.5% vs. 0%) by discharge and long-term regimen. In adjusted analysis, renal targets (HR 7.5, 2.8-19.3) and branches (HR 8.3, 2.9-23.9) were associated with increased risk for TV occlusion, but discharge and long-term regimens were not. During the study period, 41 patients (17%) experienced 51 bleeding events. There were no differences based on discharge or long-term medication regimens (Table I). However, the type of bleeding event differed by discharge regimen. The majority of bleeding events were minor (73%) and gastrointestinal (GIB) (57%). While bleeding events did not differ by discharge regimen, they did differ by long-term regimen (1-year: SAPT: 3.3% vs. DAPT 8.3% vs. AC+SAPT 12.2%, p=0.043). In adjusted analysis, only AC+SAPT (HR 3.5, 1.4-8.6) was associated with increased risk of bleeding events compared to SAPT, while DAPT was not.
Conclusions: Discharge medication regimens, including DAPT, may not be associated with freedom from TV occlusion following F/BEVAR. Bleeding complications are common and increased with AC, but not DAPT. Prospective, randomized control trials are needed to further delineate optimal AP/AC regimens given the complexity of F/BEVAR and high-risk comorbidity profile of patients treated.
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