Patients with atrial fibrillation (AF) or venous thromboembolism (VTE) that undergo percutaneous coronary interventions (PCIs) require multiple antithrombotic medications. Clinicians must balance the risk of thromboembolism and coronary artery re-occlusion with the risk of bleeding. Antithrombotic guidelines in this patient population are evolving. The objective of this study was to describe changes to antithrombotic therapy and associated outcomes occurring 12-months following PCI in patients requiring ongoing anticoagulation therapy for AF or VTE.
Potential patients were identified from queries of electronic medical records using International Classification of Disease 10th edition (ICD-10) and Current Procedural Terminology (CPT) codes for AF, VTE, and PCI. Electronic records of qualifying patients were manually reviewed to verify proper categorization, changes to antithrombotic therapy at 12-months following PCI, and predetermined outcomes occurring during the next 6-months. Outcomes included: major bleeding, clinically relevant non-major bleeding (CRNMB), major adverse cardiovascular events (MACE), stroke or systemic embolism, and all-cause mortality.
From July 1, 2014 to July 1, 2018, 114 patients met all inclusion criteria. Patients receiving anticoagulation therapy at 12 months post PCI were classified into the following groups according to antiplatelet therapy status: no antiplatelet therapy (n=16), single antiplatelet therapy (n=81), or dual antiplatelet therapy (n=17). Between the 12 and 18 months following PCI there were 24 outcome events including 3 major bleeds, 7 CRNMB, 6 MACE, 2 VTE, 1 stroke, and 5 deaths. All but one major bleeding episode occurred in the single antiplatelet therapy group.
Most anticoagulated patients were continued on antithrombotic therapy at 12-months post PCI. Adverse outcomes were common in anticoagulated patients who continued antiplatelets beyond 12 months. There was significant variability in antithrombotic prescribing patterns 12 months post PCI suggesting a potential opportunity for developing a process to standardize care in this patient population.Recommend0 recommendationsPublished in