Does prior stroke affect ischemia or bleeding risk after percutaneous coronary intervention?

This study investigated the risk of ischemia (IR) or bleeding (BR) after stroke in patients undergoing percutaneous coronary intervention (PCI). They found that patients with prior stroke had higher IR/BR after PCI. 

Coronary artery disease (CAD) is caused by blockages and reduced blood flow to the heart. Percutaneous coronary intervention (PCI) is a surgical procedure to remove blockages. There is a risk of ischemia (reduced blood flow, IR) after PCI. To reduce this risk patients will take drugs to prevent clotting. This is called dual antiplatelet therapy (DAPT). There is also a risk of bleeding (BR) with DAPT. 

It is important to understand the IR/BR in patients undergoing PCI. Patients with a prior history of stroke may have a greater IR/BR. There are two types of stroke. Hemorrhagic stroke (HS) occurs when a vessel ruptures and blood flow to the brain stops. Ischemic stroke (IS) occurs when a vessel becomes blocked and blood cannot flow. It is unclear if IR/BR after PCI is different in patients with prior HS/IS. 

This study included 19,475 patients undergoing PCI. These patients were part of 3 separate studies on PCI. Patients with a previous stroke (10.6%) were compared to those who did not have a stroke before (non-stroke; NS). Stroke was categorized as HS (1.5%) or IS (9.1%). Patient data were compared to assess the IR/BR after PCI.

Patients with prior IS stopped DAPT earlier than HS and NS patients. The number of brain bleeds was higher in HS patients (6.8%) compared to IS (2.5%) and NS patients (1.3%). The total number of bleeding events was higher in HS and IS patients compared to NS patients. IR events including stroke and heart attack were higher in both HS and IS patients compared to NS.

The authors concluded that patients with a prior stroke had higher ischemic and bleeding risk after PCI. 

21% of patients with prior HS also had prior IS. Patient profiles were variable so other factors could affect the findings in this study. More controlled studies are needed.