Aim. To evaluate and compare the prognostic value of various scales on the risk of upper gastrointestinal bleeding (GIB) in patients with stable coronary artery disease (CAD) in the Russian population.Material and methods. The study included patients with stable CAD — participants of the REGATTA-1 prospective single-center registry. The number of points was assessed according to the reference score of the 2015 European Society of Cardiology (ESC), PRECISE-DAPT, ABC-HBR and REACH scores, as well as two Russian scores — the REGATTA score and the ORACUL score, originally developed for patients with acute coronary syndrome (ACS).Results. A total of 623 patients were included (median age 60 [53, 68] years; men — 78,7%). Over 2,5 [1,1-14,7]-year follow-up, the incidence of major and clinically significant GIBs was 1,9 cases/100 people/year. There were following score with sufficient predictive value: REGATTA — Area Under the Receiver Operating Characteristic Curve (ROC AUC) 0,865, p<0,0001, F1 measure 0,4; ESC 2015 — ROC AUC 0,791, p<0,0001, F1 measure 0,243; PRECISE-DAPT — ROC AUC 0,713, p=0,001, F1 measure 0,397, and ABC HBR — ROC AUC 0,743, p<0,01, F1 measure 0,432. The REGATTA score is characterized by the greatest predictive significance (p<0,05 for all pairwise comparisons). The original ORACUL scale (ROC AUC 0,507, p=0,9, F1 measure 0,150) and the REACH scale (ROC AUC 0,572, p=0,164, F1 0,177) did not significantly predict the GIB risk. The identified patterns maintained when analyzed with binary values "high risk/no high risk" for each of the scales. Modified ORACUL scale for stable coronary artery disease after recalibration using binary analysis was not inferior to the ESC 2015, PRECISE-DAPT and ABC-HBR scales (ROC AUC — 0,645 (p=0,002)).Conclusion. The universal PRECISE-DAPT and ABC-HBR scales can be used to assess the GIB risk of along with the 2015 ESC score in patients with stable coronary artery disease. The Russian REGATTA score has the best predictive ability, but its limitation is the lack of external validation. Modification and recalibration of the ORACUL scale significantly increases its predictive value in patients with stable coronary artery disease.

Russian Society of Cardiology (RSC)With the participation of: the National Society for the Study of Atherosclerosis (NOA), the Atherothrombosis National Society, the Russian Association of Cardiovascular Surgeons, the Russian Society of Cardiosomatic Rehabilitation and Secondary Prevention (RosOKR), the Russian Society of Radiologists and Radiologists (RSRR), the Russian Association of Ultrasound Diagnostics Specialists in Medicine (RASUDM), the Russian Scientific Society for X-ray Endovascular Diagnosis and Treatment

Introduction. Patients undergoing elective myocardial revascularization require 6 months of dual antiplatelet therapy (DAPT), including aspirin and clopidogrel. In patients with multifocal atherosclerotic lesion (MFA), it may be reasonable to extend the DAPT. Additional consideration of laboratory parameters, which reflect sensitivity to clopidogrel, may be useful in assessing the effectiveness and safety of prolongation DAPT.Aim. To determine the significance of laboratory parameters reflecting sensitivity to clopidogrel in assessing the prognosis of patients with MFA receiving long-term DAPT after myocardial revascularization.Materials and methods. 128 patients with coronary artery disease (CAD) and MFA were included from the prospective register of antithrombotic therapy (REGATTA-1), ClinicalTrials NCT04347200. Inclusion criteria were elective myocardial revascularization, the use of DAPT planned for at least one year and additional determination sensitivity to clopidogrel – residual platelet reactivity and polymorphisms of the CYP2C19* gene. Thrombotic events (TO) in any vascular beds and hemorrhagic complications(GO) (BARC 2–5).Results. The median of DAPT was 380 days, IQR (346. 447). The total incidence of thrombotic events and hemorrhagic complications (the majority – BARC 2) were 9.9 and 4.4 cases per 100 patient-years. The frequency of bleeding events was 4.4 cases per 100 patient-years. There was no association of TO with the PRU and pharmacogenetic parameters. CYP2C19*17 allele carriers tended to have a higher frequency of GO rates compared compared to wild genotype carriers (63% versus 29%, p = 0.05). The frequency of GO in patients with PRU 147 (two lower quintiles) was higher compared with the frequency of GO in the three upper quintiles of the distribution: 12% vs. 3%, p = 0.041. PRU lost significance in multivariate analysis and an independent laboratory predictor of GO was the carriage of CYP2C19*17 alleles (HR 4.8).Conclusion. In patients with MFA who are candidates for long-term DATT after myocardial revascularization, an additional pharmacogenetic assessment of the effect of clopidogrel (allelic variants of CYP2C19*17) can be discussed in order to predict bleeding

We present reversible cardiomyopathy in a patient recovered from severe COVID-19. In addition to heart failure, the patient had thrombosis of abdominal aorta, lower extremity arteries and kidney infarction. At admission, the left ventricular ejection fraction (LVEF) was 18%. Primary diagnosis was SARSCoV2-induced myocarditis. However, cardiac MRI with delayed gadolinium enhancement revealed no fibrosis or active myocarditis. Troponin was normal. Atrial fibrillation persisted. Arrhythmia was first verified a week before COVID-19. Previously effective treatment failed to support adequate heart rate after COVID-19. Angiography revealed subtotal stenosis of the left anterior descending artery. After strict rate control and percutaneous coronary intervention, the patient was discharged on optimal medical therapy. Six months later, LVEF was 45%. Pulmonary vein isolation and cardioversion were performed. One week later, LVEF was 60%. In our opinion, this was a mixed cardiomyopathy with predominant role of AF and myocardial ischemia. Probably, COVID-19 modulated natural course of cardiovascular pathology. We also discuss potential contribution of COVID-19 to the course of cardiovascular pathology in long-term period of disease. © 2023, Media Sphera Publishing Group. All rights reserved.

AIM:Patients with atrial fibrillation (AF) at high risk of thromboembolic complications who have had bleeding should strive to resume anticoagulant therapy. Existing traditional scales for assessing the risk of hemorrhagic complications are not highly specific for the risk of recurrent bleeding. Thus, searching is needed for clinical and laboratory predictors to identify patients who require a personalized monitoring regimen. The aim of the study was to assess the incidence rate and predictors of recurrent major and clinically significant bleeding in patients with AF after resumption of the anticoagulant therapy, as well as the contribution of changing the anticoagulant to the treatment safety.MATERIAL AND METHODS:Based on a 5-year follow-up of 95 patients with AF who have had major and clinically significant bleeding, the incidence and clinical factors determining the recurrence of hemorrhagic complications were assessed.Results According to the data of the 5-year follow-up, the recurrence rate of major/clinically significant bleeding was 16.9/100 patient-years. Changing the oral anticoagulant significantly reduced the risk of relapse after clinically significant bleeding and did not affect the risk of recurrence of major bleeding. The predictor for relapse of major/clinically significant bleeding during the therapy resumption was chronic kidney disease with a decrease in creatinine clearance to less than 60 ml/ min, which increased the risk of relapse 2.27 times (95% confidence interval: 1.1253-4.6163; p=0.0221).CONCLUSION:The development of serious bleeding in a patient at high risk of thrombotic complications always requires a reassessment of risk factors and an adequate choice and dosage of the anticoagulant. Development of a unified protocol for the management of AF patients receiving anticoagulants and having a high risk of bleeding is essential and will reduce the risk of adverse outcomes.

Russian Society of Cardiology, National Society of Preventive Cardiology

The article is devoted to the results of the subanalysis published after release of the AUGUSTUS trial. The most important conclusion of the parent trial is the evidence that weekly aspirin therapy is sufficient to prevent thrombotic complications in the majority of patients with AF and ACS, as well as those undergoing elective PCI, and that aspirin therapy can be extended up to 1 month after PCI only in a part of patients with additional risk factors for ischemic events and a low risk of bleeding. Four years have passed since the publication of the AUGUSTUS trial results, and all subsequent subanalyses of the trial confirmed its results. The safety and efficacy advantages of apixaban over warfarin were shown to be independent of renal function and consistent with the overall trial results. The advantages of apixaban and the association of aspirin with bleeding were similar in both stroke and non-stroke patients with AF and were dose-independent when a dose was reduced to 2.5 mg twice in accordance with the reduction criteria. The advantages of apixaban over warfarin lasted regardless of time spent in the therapeutic range in the warfarin group. The advantages of apixaban over warfarin and the association of long-term intake of aspirin with bleeding rates persisted in patients with high and low baseline risk of bleeding and stroke. All subanalyses of the AUGUSTUS trial confirmed the efficacy and safety of apixaban, as well as the option to discontinue aspirin at the outpatient stage in the majority of patients with AF, who underwent elective PCI or ACS.

Cancer is one of the most significant risk factors for venous thromboembolic complications (VTEC), which combines deep vein thrombosis and pulmonary embolism. Of the many well-known risk factors for VTEC, only cancer is associated with a 4-fold increased risk of venous thrombosis, and in cancer patients receiving chemotherapy the risk increases by up to 6.5-fold. Venous thrombosis is increasingly common in cancer patients and contributes significantly to the course of the underlying disease and mortality, especially when combined with additional risk factors, the most significant of which are surgery and chemotherapy treatment. The prevention and treatment of VTEC in cancer patients is a challenge, primarily due to the pathogenesis of cancer-associated thrombosis, the presence of additional risk factors associated with cancer, the high risk of haemorrhagic complications, reduced renal function and the recurrent nature of VTEC. Aspects of safe prevention remain an integral part of the management of patients with active cancer. The most vulnerable periods for the development of VTEC are the periods when the patient is hospitalised for surgical or therapeutic treatment and the long period of chemotherapy treatment on an outpatient basis. A comprehensive approach to the prevention of VTEC in patients with cancer should primarily involve careful selection of high-risk patients at each stage of treatment of the malignancy; these patients are the ones who will benefit most from drug thromboprophylaxis. The treatment of an already confirmed VTEC in a cancer patient always involves the additional challenges of drug interactions and increased haemorrhagic risk due to prolonged use of treatment doses of anticoagulants, which may in turn affect the effectiveness of chemotherapy or the efficiency and safety of anticoagulant therapy.

This review is devoted to the aspects of anticoagulant therapy in patients with atrial fibrillation in the light of the modern understanding of this type of arrhythmia as a polymorbid continuously developing syndrome. According to experts, the management strategy of this category of patients is based on an integrated assessment, including the risk of stroke, the presence of symptoms, assessment of structural heart disease and mandatory accounting of concomitant pathology. In this approach, the appointment of anticoagulant therapy as a prevention of stroke in a patient with atrial fibrillation is put in the first place. At the same time, experts emphasize the need for a dynamic reassessment of risks, as well as the use of a multidisciplinary team of specialists to make a complex decision. The review summarizes the basic concepts of the integrated approach, describes various variants of clinical scenarios, including aspects of anticoagulant maintenance of cardioversion and catheter ablation, multicomponent therapy after percutaneous coronary intervention. A separate chapter is devoted to modern algorithms of perioperative management of a patient receiving oral anticoagulants, which is based on the stratification of interventions according to the risk of perioperative bleeding and the characteristics of the anticoagulant prescribed to the patient. The place of dabigatran in the primary and secondary prevention of stroke and systemic embolism in patients with atrial fibrillation is described, studies that served as the basis of the evidence base for the use of dabigatran in patients with atrial fibrillation are presented. The data of register observations, meta-analyses devoted to the evaluation of the efficacy and safety of dabigatran in certain categories of patients (elderly patients, patients with chronic heart failure, diabetes mellitus) are presented, which form the basis of decision-making in real clinical practice.

Introduction . Lengthening the period of direct oral anticoagulant (DOAC) withdrawal before intervention is not allowed. Chronic kidney disease (CKD), impaired liver function, extremely low or high body mass, chronic heart failure (CHF), and age > 90 years can increase blood DOAC levels. DOAC therapy does not require routine laboratory monitoring. However, there are coagulation tests that can be used to detect the presence of a drug in blood. Duration of DOAC discontinuation and the appropriateness of assessing residual anticoagulant concentrations before intervention with a high bleeding risk in a special category of patients is to be defined. Aim . To measure residual concentrations of anticoagulants and their association with perioperative bleeding risk in patients with AF using DOACs in blood samples collected immediately before TAVI. Materials and methods . The 94 patients with atrial fibrillation (AF) included in the study were characterized by senile age, a high risk of thromboembolic complication (ТС), many comorbidities, and a high prevalence of senile asthenia. The apixaban and rivaroxaban concentrations were measured according to the value of anti-Xa activity and control plasmas with normal levels of coagulation factors (Diagnostica Stago, France). Results . The median time of DOAC withdrawal before TAVI was 60 hours [47.5; 72]. However, the DOAC concentration exceeded 30 ng/ml in 1/5 patients (19.2%), and stage 3 or more CKD was more common in these patients. Our study showed the relationship between DOAC concentration and the duration of DOAC withdrawal period. However, the relationship between DOAC concentration and bleeding that occurred in the perioperative period could not be found. Patients with signs of CKD were older and had a lower BMI as compared to patients without CKD. Conclusion . Our data showed the relationship between the DOAC concentration and the duration of DOAC withdrawal period. No relationship was found between DOAC concentrations and bleeding.

Aim. To identify factors determining the prognosis after elective myocardial revascularization in patients with coronary artery disease (CAD) with multifocal atherosclerosis (MFA). Material and methods. The study is based on the prospective registry REGATA-1, ClinicalTrials NCT04347200 (1500 patients with stable coronary artery disease; men, 78,6%, age, 65±8,7 years). We selected 238 patients with MFA, the criteria of which were multivessel CAD (at least 2 arteries) in combination with stenosis ≥50% of at least one of the peripheral vascular system. The selection criteria was elective myocardial revascularization followed by dual antiplatelet therapy for at least 6-12 months. Unfavorable outcomes were analyzed, namely thrombotic events (TEs) in any vascular system and bleeding (BARC type 2-5). Results. The median follow-up was 859 days (interquartile range [523;1665]). Thrombosis dominated in the structure of events: the total incidence of TEs was 18,5% (including fatal — 4,2%), and the total incidence of bleeding was 7,5% (including BARC type 3 — 1,7%). Predictors of TE were smoking (hazard ratio (HR)=2,18), myocardial infarction (HR=2,6) and ischemic stroke/transient ischemic attack (HR=2,81) more than a year ago, as well as revascularization with percutaneous coronary intervention (PCI) versus coronary artery bypass grafting. For PCI, the prognosis was worse in case of incomplete revascularization, as well as when the intervention was limited to ≤2 arterial segments and the total length of stents <26 mm. Among all predictors of poor prognosis, the most significant was high-risk PCI in combination with dual antiplatelet therapy for <12 months (HR=6,7). Conclusion. For the first time, TE predictors in patients with CAD and MFA have been identified, which will improve secondary prevention in a category of patients with an extremely high risk of TEs.

Двойная антитромбоцитарная терапия (ДАТТ), состоящая из аспирина и ингибитора P2Y12-рецептора тромбоцитов, является золотым стандартом терапии для пациентов, перенесших чрескожное коронарное вмешательство (ЧКВ). Персонификация терапии в историческом аспекте, основанная на функциональном или генетическом тестировании, позволила рассмотреть индивидуальные схемы лечения, которые могут включать эскалацию или деэскалацию терапии, особенно у пациентов с высоким риском тромботических осложнений (недавний эпизод острого коронарного синдрома). Кроме того, в последние годы в отношении пациентов после ЧКВ, имеющих высокий риск геморрагических осложнений, актуальным становится сокращение длительности ДАТТ под контролем остаточной реактивности тромбоцитов, приводящее к снижению частоты геморрагических исходов. В статье отражена эволюция подходов к персонификации терапии и позиции международных экспертов.

Introduction . Pulmonary embolism (PE) accounts for about 10% in the mortality pattern among cancer patients, which is the second most frequent cause of death. Aim . To identify and characterize patients with active cancer and VTEC receiving chemotherapy (CT) based on the retrospective review of medical records provided by Moscow City Oncology Hospital No. 62 (MCOH No. 62) for the period from 01.2018 to 04.2020. Materials and methods . Medical records of 3,912 patients receiving chemotherapy treatment cycles in the departments of MCOH No. 62 were reviewed. 227 (5.8%) patients in whom the underlying disease course was complicated by VTEC were selected. Sites of primary tumours, n (%): stomach – 37 (16.3); colon and rectum – 36 (15.9); uterus, cervix, ovaries – 31 (13.7); lungs – 23 (10.1); kidneys, ureters and bladder, testicles – 19 (8.4); pancreas – 18 (7.9); soft tissues – 14 (6.2); mammary gland – 13 (5.7); lymphoma, myeloma – 8 (3.5); Ear Nose Throat (ENT) tumours – 7 (3); others – 21 (9.3). Results . The majority of patients (176 (77.5%)) had a sum Khorana score <3, 51 (22.5%) patients had Khorana scores ≥ 3, which corresponds to a high thrombotic risk. 29 (12.7%) patients died. The hospital physicians assessed the causes of death as follows: 16 patients died from pulmonary embolism, of which 13 (81%) had a sum Khorana score <3; 13 patients died due to progression of cancer. Conclusions . VTEC most commonly occurred in patients with gastrointestinal cancer (32.2%) and genito-urinary system cancer (22.1%). Half (54.5%) of VTEC occurred in the first 3 months of chemotherapy treatment. The Khorana scale is non-perfect in ‘real-life’ clinical practice (only 22.5% of patients with verified VTEC had a high thrombotic risk, and 81% of patients who died due to PE had a low and medium risk of VTEC).

ЦЕЛЬ ИССЛЕДОВАНИЯ Оценить частоту смерти от всех причин и выявить клинические предикторы неблагоприятного прогноза на основании проспективного наблюдения за больными фибрилляцией предсердий (ФП), подвергнутыми транскатетерной имплантации аортального клапана (ТИАК). МАТЕРИАЛ И МЕТОДЫ Исследование представляет собой анализ когорты больных ФП, подвергнутых операции ТИАК в НМИЦ кардиологии им. акад. Е.И. Чазова за 2020—2022 гг. В работу включены 130 пациентов с ФП (61 мужчина), медиана возраста 79 лет. Подавляющее большинство больных относилось к категории высокого риска тромбоэмболических осложнений, медиана суммы баллов по шкале CHA2DS2—VASc составила 5. РЕЗУЛЬТАТЫ Летальность в течение 1,5 года среди больных ФП, перенесших успешную ТИАК, составила 8,4/100 пациенто-лет. В структуре летальности преобладала (73,3%) смерть от сердечно-сосудистых причин. Предикторами ее развития от всех причин среди исследуемой группы пациентов оказались 2 признака: наличие старческой астении и хронической болезни почек ≥III стадии. У больных ФП, переживших операцию ТИАК, предиктором развития всех нежелательных событий в течение 1,5 года наблюдения оказалась онкологическая патология.

Disclaimer. The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

Introduction Recent studies are aimed to find laboratory predictors of bleeding complications in patients receiving various regimens of antithrombotic therapy. One of these biomarkers is GDF-15. Purpose To study the significance of GDF-15 in relation to the development of bleeding outcomes in CAD patients with multifocal atherosclerosis, receiving combined antithrombotic therapy. Methods The data was obtained from the prospective registry REGATA-1 (NCT04347200). 122 patients (90 males), median age 69 [IQR 64; 76] yrs) with CAD and peripheral atherosclerosis of at least one vascular territory (≥ 50%), were enrolled. Half of the patients (47.5%) with sinus rhythm received acetylsalicylic acid in combination with rivaroxaban 2.5 mg bid. Other patients (52.5%) with concomitant atrial fibrillation received direct oral anticoagulants in combination with antiplatelet therapy after elective PCI. Median follow-up was 10 months [IQR 7.0;12.0]. The safety end point was BARC 2–5 bleedings. Plasma samples for GDF-15 identification were taken at the inclusion and analyzed using ELISA. Results Frequency of BARC 2–5 bleedings was 14%. Median GDF-15 level was 1248.5 pg/ml [947.8; 1791.0]. According to the quartile analysis, GDF-15 values in the top three quartiles of the distribution (cut-off value > 948 pg/ml) were associated with higher frequency of bleeding events: 3.1% versus 17.8%, P = 0.0411. Bleeding-free survival in groups, formed depending on the level of GDF-15 (948 > and ≤ 948 pg/ml), was 96.7% vs. 82.2%, respectively, Log-Rank P = 0.0408. Conclusions Increase in GDF-15 level (> 948 pg/ml) is associated with the development of BARC 2-5 bleedings in CAD patients with multifocal atherosclerosis, receiving combined antithrombotic therapy.

A fatal case of severe stenosis of the aortic orifice in a patient with not diagnosed in time, long-term persistent covid infection is presented. The patient was hospitalized to resolve the issue of surgical correction of the aortic stenosis. On admission, there were symptoms of circulatory failure at the level of 3–4 functional class according to NYHA and angina pectoris clinic. A detailed collection of anamnesis about the epidemiological environment and symptoms of pneumonia suffered in the fall of 2020 raised suspicions of its covid genesis. Subsequently, this assumption was confirmed by the data of laboratory, instrumental studies, as well as the results of the pathological and anatomical autopsy. The study of microslides showed signs of extensive vasculitis with thrombosis of small branches of the pulmonary artery and foci of pneumofibrosis of various degrees of prescription, which also testified in favor of the transferred covid infection. Taking into account the severity of the patient’s condition upon admission, it was not possible to perform emergency intervention on the aortic valve. After stabilization of the state and regression of the phenomena of circulatory failure, it was planned to simultaneously perform endovascular revascularization of the coronary valve bed and transcatheter aortic valve replacement. The planned surgical intervention failed. The immunosuppressive effect of the SARS-CoV-2 virus, apparently, led to the activation of autoflora and an increase in inflammation for nosocomial infection. Bilateral polysegmental bacterial pneumonia that joined during hospitalization, against the background of postcoid changes in the lung parenchyma, contributed to the development of acute coronary syndrome with ventricular arrhythmias. The patient died from acute cardiopulmonary failure. The article also presents ideas about the operational tactics of managing patients with aortic stenosis in a pandemic.

Introduction . Multifocal atherosclerosis (MFA) in patients with CHD is a key risk factor for thrombotic complications (TC). There are little data on the long-term prognosis in patients with multivessel CHD combined with carotid artery lesions. Objective . To assess prognostic negative outcomes (thrombosis and bleeding) in patients with CHD and MFA undergoing revascularization procedures – coronary artery bypass graft surgery and, in case of high risk of ischemic stroke, carotid endarterectomy. Materials and methods . A total of 189 patients with stable multivessel coronary artery disease who successfully underwent coronary bypass graft surgery and had concomitant atherosclerosis of the carotid arteries ≥50% were included in the study. The exclusion criterion was chronic use of oral anticoagulants. The choice of antithrombotic therapy after the surgical intervention was determined by the attending physicians. The efficacy endpoint was defined as the sum of TC including cardiovascular death, acute coronary syndrome, ischemic stroke, acute lower limb ischemia, and the need for emergency revascularization of the carotid or coronary basins. BARC bleeding types 2-5 were considered as a safety endpoint. Results . The median follow-up period was 37 months. [MR 25.0; 45.0]. The cumulative incidence of TC was 11.1%, BARC 2-5 bleeding was 4.8%. One or two antiplatelet agents were prescribed at discharge in 87.3% of cases, and in 12.7% – a combination of acetylsalicylic acid (ASA) and oral anticoagulant (OAC) for up to 6 months. The incidence of thrombotic complications was not significantly different in the mono- or dual antiplatelet therapy groups. The combination therapy group (OAC + ASA) was characterized by the highest number of comorbidities. When analyzing the TC for the first 6 months. (before anticoagulant withdrawal) there was no significant difference between the groups of antiplatelet therapy and the combination of ASA and OAC (Log-Rank, p = 0.4669). The proportion of patients who survived the entire follow-up period without developing TC was significantly higher in the group compared to the initial combination therapy group: 0.83 versus 0.50 (Log-Rank, p = 0.0101). Conclusion . Despite complete revascularization, the incidence of TC during the two years of follow-up was high. In the combination therapy group, anticoagulant withdrawal led to an increased incidence of TC.