Ischemic and Bleeding Events in Patients with Myocardial Infarction Undergoing Percutaneous Coronary Intervention Who Require Oral Anticoagulation: Insights from the Canadian Observational AntiPlatelet sTudy (COAPT)

• Published in: The American heart journal 2016-10, Vol.180, p.82-89
• Main Authors: Sra, Steven, MD, Tan, Mary K., MSc, Mehta, Shamir R., MD, MSc, Fisher, Harold N., MD, Déry, Jean-Pierre, MD, Welsh, Robert C., MD, Eisenberg, Mark J., MD, MPH, Overgaard, Christopher B., MD, MSc, Rose, Barry F., MD, Siega, Anthony J. Della, MD, Cheema, Asim N., MD, Wong, Brian Y.L., MD, Henderson, Mark A., MD, Lutchmedial, Sohrab, MD, CM, Lavi, Shahar, MD, Goodman, Shaun G., MD, MSc, Yan, Andrew T., MD
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Age; Aged; Angina pectoris; Anticoagulants; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Body mass index; Cardiovascular; Clinical medicine; Coronary vessels; Data collection; Diabetes; Drug Therapy, Combination; Family medical history; Female; Heart attacks; Heart failure; Heart rate; Heart surgery; Hemorrhage - chemically induced; Hospitalization; Humans; Hypertension; Lung diseases; Male; Middle Aged; Myocardial Infarction - drug therapy; Myocardial Infarction - therapy; Patients; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Prospective Studies; Purinergic P2Y Receptor Antagonists - adverse effects; Purinergic P2Y Receptor Antagonists - therapeutic use; Statistical analysis; Stroke
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2016.07.015

Abstract Background Since the introduction of newer, more potent P2Y12 receptor inhibitors (P2Y12 ris), 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, Dec/11-May/13) describing P2Y12 ri 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; ASA + P2Y12 ri) or triple therapy (ASA + P2Y12 ri + OAC). Results Of the 2034 patients at discharge, 86% (n = 1757) were on DAPT, while 14% (n = 277) were on triple therapy (50% warfarin, 50% non-vitamin K oral anticoagulant [NOAC]). The frequency of newer P2Y12 ri 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 P2Y12 ri compared to those receiving clopidogrel (75% vs 41%, respectively, P < .0001). The unadjusted and adjusted events of 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 P2Y12 ris. Patients on triple therapy had higher risk at baseline, with higher unadjusted and adjusted MACE and bleeding events compared to those on DAPT alone. Amongst triple therapy-treated patients, there was no difference in the MACE and bleeding events regardless of the P2Y12 ri used.