Abstract 11861: Number of Antithrombotic Drugs and Association with In-Hospital Clinical Outcomes in Patients with Acute Coronary Syndromes: Results from the EPICOR Study
Purpose. To investigate the total number of antithrombotic drugs (ATD) used for the early treatment of acute coronary syndromes (ACS) in current real-world practice, and its association with in-hospital ischemic and hemorrhagic outcomes.
Methods. EPICOR (NCT01171404) is a prospective, international, observational, real-world practice, cohort study of 10,568 consecutive patients with non-fatal ACS who survived to hospital discharge. Patients were enrolled from 555 hospitals in 20 countries in Europe and Latin America between 10/2010 and 03/2011. The incidence of in-hospital bleeding episodes and ischemic events (myocardial infarction or ischemic stroke) was analyzed according to the number of antiplatelet (AP) or anticoagulant (AC) drugs.
Results. The median number of ATD used in the in-hospital treatment of ACS was 3 (P25-P75, 3-4) (Table). The median number of AP was 2 (P25-P75, 2-2), and of AC 1 (P25-P75,1-1). A total of 343 patients experienced non-fatal in-hospital bleeds and 246 experienced ischemic events. The number of ATD was significantly associated with the risk of total non-fatal in-hospital bleeding episodes (p=0.007). The incidence of bleeding increased with the number of AP (1.80%, 2.75% and 5.91% with 0-1, 2 and 3-4 AP, respectively) and AC (1.83%, 2.74% and 6.04% with 0, 1 and 2-4 AC, respectively). In contrast, no significant association (p=0.26) was found between the total number of ATD and the incidence of in-hospital ischemic events (2.52%, 2.38% and 2.04% for 0-1, 2 and 3-4 APs, respectively) and (2.30%, 2.37% and 2.22% for 0, 1 and 2-4 ACs, respectively).
Conclusions. This large international study shows a wide variation in the total number of ATD used for the initial treatment of ACS in current real-world practice. The use of a higher number of ATD was associated with a greater incidence of in-hospital bleeding but not with the incidence of ischemic events.
- © 2012 by American Heart Association, Inc.