Thrombocytopenia and Antithrombotic Regimens
thrombocytopenia, coronary artery disease, bleeding
BLEEDING, THROMBOCYTOPENIA, EVENTS, CORONARY ARTERY DISEASE, COMPLICATIONS
Many studies have demonstrated that thrombocytopenia is strongly associated with an increased risk of bleeding complications and mortality and that changing the clinical scenario of poor prognosis is difficult.Before drawing conclusions, the study findings should be carefully interpreted. First, this is a post‐hoc analysis using source data derived from a randomized trial in which an analysis of platelet counts was not prespecified. Therefore, the different treatment interventions could affect the clinical results. Second, platelet count was not available in all patients with AF (96.3%), and the cause of thrombocytopenia has not been determined. Third, despite the large number of patients included, the number of patients with AF with thrombocytopenia was very low (3.3%) and may have low statistical power for the analysis regarding major bleeding and cardiovascular events. Finally, the types of antiplatelet agent were selected as per the physician's discretion, which may have affected the end points.Therefore, thrombocytopenia is associated with a significant increase in the risk of major bleeding in patients with AF who developed CCS after 1 year of revascularization or in patients with angiographically confirmed coronary artery disease who do not require revascularization. Selecting antiplatelet and anticoagulant agents must be given special consideration for patients with thrombocytopenia continuing antithrombotic therapy. De‐escalation to rivaroxaban monotherapy may be beneficial in reducing the risk of major bleeding, although given the study limitation, well‐designed, randomized controlled trials are needed to establish this strategy.