ABSTRACT
Background
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.
Methods
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.
Results
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.
Conclusions
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 College of Pharmacy, Virtual Poster Session Spring 2021
Responses
Nice job, Eleni! You’ve put in a lot a hard work on this project and I think have produced an important finding. If you were the Chief of Cardiology at the University of Utah, what recommendations would you make to your team regarding anti platelet therapy prescribing based on the results of your project?
Couldn’t have done it without an excellent mentor!
I think it would be worthwhile to have some kind of algorithm that helped providers guide their decisions at a 6 month and 12-month follow-up appointment. It is important to consider all aspects of a patient and balance the risks of a clot vs. the risks of a bleed and having a guidance could really benefit patient outcomes.
Great poster & project! What 2 things were most important to you in the learning process of doing a project?
Learning how to use the REDCap Data Collection tool and how to accurately and efficiently scan a MAR was crucial for this project! It also taught me a lot about the behind-the-scenes research and gave me a new respect for the process!
Hope you are well!
Nice work Eleni!! What types of projects would you envision as potential follow up studies?
Hi Dr. LSM!
Thanks for “stopping by” my poster! I think it would be interesting to qualitatively analyze what the decision-making factors were for providers when they determined therapies for patients! I would like to know what their thoughts were during the process!
Interesting research. Thanks.
Thank you!!
I would love to look qualitatively at the factors for non discontinuation when appropriate. I think it is a struggle between primary care and specialists who may not understand how each feels about the others role. Very important! also – were the deaths – all deaths or associated with bleeding/cards?
I agree! That was something I considered for further research, what are the decision-making factors that providers consider when they are altering (or not altering) therapy for these patients. You make a great point about the transition of care and the need for PCPs and specialists to have appropriate communication. My outcome was all-cause mortality – some patients did have CV deaths but we did have a spectrum! Thank you for stopping by!
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