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Am Heart J. 2016 Oct;180:82-9. doi: 10.1016/j.ahj.2016.07.015. Epub 2016 Aug 7.

Ischemic and bleeding events in patients with myocardial infarction undergoing percutaneous coronary intervention who require oral anticoagulation: Insights from the Canadian observational AntiPlatelet sTudy.

Author information

1
St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
2
Canadian Heart Research Centre, Toronto, Ontario, Canada.
3
Population Health Research Institute, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada.
4
Eli Lilly Canada Inc., Toronto, Ontario, Canada.
5
Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Quebec, Canada.
6
Mazankowski Alberta Heart Institute, University of Alberta, Canadian VIGOUR Centre, Edmonton, Alberta, Canada.
7
Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
8
University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
9
Eastern Health, Memorial University, St John's, Newfoundland and Labrador, Canada.
10
Royal Jubilee Hospital and Victoria Heart Institute, Victoria, British Columbia, Canada.
11
Health Sciences North, Sudbury, Ontario, Canada.
12
Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada.
13
New Brunswick Heart Centre, CardioVascular Research NB, Saint John, New Brunswick, Canada.
14
London Health Sciences Centre, Western University, London, Ontario, Canada.
15
St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Heart Research Centre, Toronto, Ontario, Canada. Electronic address: goodmans@chrc.net.

Abstract

BACKGROUND:

Since the introduction of newer, more potent P2Y12 receptor inhibitors (P2Y12ris), practice patterns and associated clinical outcomes in patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI) and also requiring oral anticoagulation (OAC) have not been fully characterized.

METHODS:

The Canadian Observational Antiplatelet Study was a prospective, multicenter, longitudinal, observational study (26 hospitals, December 2011 to May 2013) describing P2Y12ri treatment patterns and outcomes in patients with ST-elevation and non-ST-elevation MI undergoing PCI. We describe the clinical characteristics, treatment patterns, bleeding, and ischemic outcomes over the 15-month follow-up within and between the subgroups of patients discharged on either dual-antiplatelet therapy (DAPT) (acetyl salicylic acid [ASA]+P2Y12ri) or triple therapy (ASA+P2Y12ri+OAC).

RESULTS:

Of the 2,034 patients at discharge, 86% (n = 1,757) were on DAPT, whereas 14% (n = 277) were on triple therapy (50% warfarin, 50% non-vitamin K OAC [NOAC]). The frequency of newer P2Y12ri use (prasugrel or ticagrelor) was similar in the DAPT and triple therapy groups (28% vs 26%, respectively). In the triple therapy group, NOAC use was higher in those receiving a new P2Y12ri compared to those receiving clopidogrel (75% vs 41%, respectively, P < .0001). The unadjusted and adjusted events of major cardiovascular event (MACE) and bleeding were higher in the triple therapy group. For patients on triple therapy, the bleeding or MACE events were not significantly different between those on clopidogrel versus those on ticagrelor or prasugrel.

CONCLUSION:

In this observational study of MI patients requiring PCI, 1 in 8 were discharged on triple antithrombotic therapy, of whom 26% were on newer P2Y12ris. Patients on triple therapy had higher risk at baseline, with higher unadjusted and adjusted MACE and bleeding events compared to those on DAPT alone. Among triple therapy-treated patients, there was no difference in the MACE and bleeding events regardless of the P2Y12ri used.

PMID:
27659886
DOI:
10.1016/j.ahj.2016.07.015
[Indexed for MEDLINE]

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