Abstract 2221: Triple Therapy (TTx): ASA, Thienopyridine and Oral Anticoagulation (OA) Therapy Following ST Elevation Myocardial Infarction (STEMI): Is it Safe?
While the bleeding risk of OA + ASA has been well characterized, the bleeding risk of triple therapy (OA + ASA + thienopyridine) following STEMI treated with fibrinolytic administration has not been well characterized.
Methods: Of 19,315 STEMI patients treated with fibrinolytic therapy in EXTRACT-TIMI 25 who survived to discharge, 427 pts (2.2%) were discharged on OA alone, or in conjunction with single or dual antiplatelet therapy. Bleeding complications were assessed from discharge through 30 days.
Results: Of the 427 patients, 86 (20.1%) patients were discharged on OA + dual antiplatelet therapy (TTx); 260 (60.9%) on OA + ASA; 14 (3.3%) on OA + thienopyridine (T); and 67 (15.7%) on OA alone. At 30 day follow up, there was only 1 patient (1/427 or 0.23%) with a TIMI major bleed and this patient had been treated with OA + dual antiplatelet (1/86 pts or 1.16%). There were 2 TIMI minor bleeds (2/427 or 0.47%), one patient receiving OA + ASA and the other OA alone. This compares favorably with patients on no OA at discharge (see table⇓). Of the 427 patients, 90 (21.1%) had undergone percutaneous coronary intervention during the index hospitalization. Within this group, there were no TIMI major or minor bleeds at 30 day follow up.
Conclusion: Triple therapy with OA + dual antiplatelet appears safe over the course of the initial 30 days following discharge in STEMI patients initially managed with fibrinolytic therapy.