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ANTICOAGULATION AND ANTIPLATELET PATTERNS IN PATIENTS WITH ATRIAL FIBRILLATION POST-PERCUTANEOUS CORONARY INTERVENTION
S330
Table 1. Clopidogrel was most often administered as the initial ADPri prior to PCI for both STEMI and NSTEMI, with emergency physicians being the primary prescribers. Emergency physicians were responsible for w50% of prasugrel initiation in STEMI patients and w50% of ticagrelor initiation in NSTEMI patients. Type of insurance coverage did not appear to be associated with ADPri choice, with a similar proportion of patients treated with each agent having public, private, or no insurance coverage. Switching between ADPri therapies occurred in w16%, w8%, and w21% of patients initially treated with clopidogrel, ticagrelor, and prasugrel, respectively (Figure 1). Overall, the use of newer ADPri therapy was higher at discharge with w17% receiving ticagrelor and w10% of patients receiving prasugrel. CONCLUSION: Between December 2011 and May 2013, only 1 in 4 patients with STEMI or NSTEMI undergoing PCI were discharged home on ticagrelor or prasugrel, despite strong recommendations for their use by the 2012 Updated Canadian Cardiovascular Society Antiplatelet Guidelines. These findings suggest an opportunity to improve upon the frequency of use of the newer ADPri at index hospitalisation and discharge in Canadian MI patients undergoing PCI.
Eli Lilly Canada Inc.
Canadian Journal of Cardiology Volume 30 2014
533 ANTICOAGULATION AND ANTIPLATELET PATTERNS IN PATIENTS WITH ATRIAL FIBRILLATION POST-PERCUTANEOUS CORONARY INTERVENTION EA Woods, ML Ackman, MM Graham, SL Koshman, RM Boswell, AR Barry Edmonton, Alberta BACKGROUND:
Guidelines recommend the use of triple antithrombotic therapy (TAT), defined as ASA, clopidogrel, and warfarin, in patients with non-valvular atrial fibrillation (NVAF) who undergo percutaneous coronary intervention with stent implantation (PCI). This is based on observational data, expert opinion, and standard of care. METHODS: The objective of this study was to characterize the use of anticoagulant and antiplatelet therapy at discharge in patients with NVAF post-PCI at our institution, and to identify determinants of the most commonly utilized regimens. A retrospective chart review was conducted at the Mazankowski Alberta Heart Institute from January 1, 2011 to December 31, 2013. Adult inpatients with NVAF and a CHADS2 score 1 who received PCI were included. Patients with mechanical devices requiring anticoagulation or who underwent cardiac surgery during hospitalization were excluded. Patients were identified using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database and medical records. The primary outcome was the proportion of patients discharged on TAT. RESULTS: A total of 108 patients were screened with 74 patients included. The median age was 73 years and 73% were male. The majority of patients had dyslipidemia (70%) and hypertension (60%). The median CHADS2 and HASBLED scores were 2 and 3, respectively. Nine patients (12.2%) had a previous gastrointestinal bleed (GIB). Table 1 summarizes the discharge therapy results.
Male patients were more likely to receive TAT in a multivariate logistic regression analysis. No patients with a previous GIB received TAT. Positive predictors in a multivariate logistic regression analysis for use of DAT included female sex and previous GIB. CONCLUSION: Despite a guideline-based indication, less than half of patients received TAT. Non-evidence based combinations of NOACs and ticagrelor were used in one-fifth of patients. Other than consideration of GIB, the rationale for using DAT in place of TAT was unclear. Further studies are needed to elucidate variance from guideline-based therapy.
Table 1. Clopidogrel was most often administered as the initial ADPri prior to PCI for both STEMI and NSTEMI, with emergency physicians being the primary prescribers. Emergency physicians were responsible for w50% of prasugrel initiation in STEMI patients and w50% of ticagrelor initiation in NSTEMI patients. Type of insurance coverage did not appear to be associated with ADPri choice, with a similar proportion of patients treated with each agent having public, private, or no insurance coverage. Switching between ADPri therapies occurred in w16%, w8%, and w21% of patients initially treated with clopidogrel, ticagrelor, and prasugrel, respectively (Figure 1). Overall, the use of newer ADPri therapy was higher at discharge with w17% receiving ticagrelor and w10% of patients receiving prasugrel. CONCLUSION: Between December 2011 and May 2013, only 1 in 4 patients with STEMI or NSTEMI undergoing PCI were discharged home on ticagrelor or prasugrel, despite strong recommendations for their use by the 2012 Updated Canadian Cardiovascular Society Antiplatelet Guidelines. These findings suggest an opportunity to improve upon the frequency of use of the newer ADPri at index hospitalisation and discharge in Canadian MI patients undergoing PCI.
Eli Lilly Canada Inc.
Canadian Journal of Cardiology Volume 30 2014
533 ANTICOAGULATION AND ANTIPLATELET PATTERNS IN PATIENTS WITH ATRIAL FIBRILLATION POST-PERCUTANEOUS CORONARY INTERVENTION EA Woods, ML Ackman, MM Graham, SL Koshman, RM Boswell, AR Barry Edmonton, Alberta BACKGROUND:
Guidelines recommend the use of triple antithrombotic therapy (TAT), defined as ASA, clopidogrel, and warfarin, in patients with non-valvular atrial fibrillation (NVAF) who undergo percutaneous coronary intervention with stent implantation (PCI). This is based on observational data, expert opinion, and standard of care. METHODS: The objective of this study was to characterize the use of anticoagulant and antiplatelet therapy at discharge in patients with NVAF post-PCI at our institution, and to identify determinants of the most commonly utilized regimens. A retrospective chart review was conducted at the Mazankowski Alberta Heart Institute from January 1, 2011 to December 31, 2013. Adult inpatients with NVAF and a CHADS2 score 1 who received PCI were included. Patients with mechanical devices requiring anticoagulation or who underwent cardiac surgery during hospitalization were excluded. Patients were identified using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database and medical records. The primary outcome was the proportion of patients discharged on TAT. RESULTS: A total of 108 patients were screened with 74 patients included. The median age was 73 years and 73% were male. The majority of patients had dyslipidemia (70%) and hypertension (60%). The median CHADS2 and HASBLED scores were 2 and 3, respectively. Nine patients (12.2%) had a previous gastrointestinal bleed (GIB). Table 1 summarizes the discharge therapy results.
Male patients were more likely to receive TAT in a multivariate logistic regression analysis. No patients with a previous GIB received TAT. Positive predictors in a multivariate logistic regression analysis for use of DAT included female sex and previous GIB. CONCLUSION: Despite a guideline-based indication, less than half of patients received TAT. Non-evidence based combinations of NOACs and ticagrelor were used in one-fifth of patients. Other than consideration of GIB, the rationale for using DAT in place of TAT was unclear. Further studies are needed to elucidate variance from guideline-based therapy.