539 Real-World Selection of Antithrombotic Strategy in Patients Requiring Oral Anticoagulation After Percutaneous Coronary Intervention

Abstract

Approximately 5% of patients undergoing percutaneous coronary intervention (PCI) require chronic oral anticoagulation (OAC). We sought to review real-world antithrombotic therapy (ATT) strategies after PCI from a Melbourne hospital, and to analyse related bleeding events. All OAC patients undergoing PCI between 2015 and 2018 were included. The cohort was stratified into dual therapy (DT, 1 antiplatelet+OAC), triple therapy (TT) or dual antiplatelet therapy (DAPT) groups. The cohort consisted of 78 patients (28% female, 71% ACS), mean age 72.1±9.8 years and CHA2DS2-VASc score of 3.0±1.5 at time of PCI. Over 80% were on OAC for AF. All patients on TT but only 15% on DT with warfarin, and none on DT with NOAC were discharged on ASA. The figure shows the selection of P2Y12 inhibitors at discharge. Five minor bleeds occurred in-hospital (TT=3, DT=2) and three out-of-hospital at 30-days (TT=1, DT=2). No bleeding occurred in DAPT patients. In this analysis, triple therapy was the most common strategy after PCI followed by dual therapy in patients requiring oral anticoagulation. Clopidogrel and ticagrelor respectively were the most common P2Y12 inhibitors used in TT and DT groups. Aspirin was omitted when a DT strategy was used with NOAC. Regardless of ATT strategy, bleeding rates were low.