Abstract 12891: Predictors of Net Adverse Cardiovascular Events in Patients on Triple Antithrombotic Therapy
Introduction: Patients on dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) often have indications for concurrent oral anticoagulation or triple antithrombotic therapy (TT). While TT may decrease ischemic complications, it may confer increased bleeding risk.
Hypothesis: We set to determine predictors of complications in patients on TT. In particular, we sought to determine if use of ticagrelor in TT is associated with higher complications.
Methods: Patients discharged on TT after PCI were followed prospectively for 12 months. The primary endpoint was a composite of ischemic (death, myocardial infarction, stroke) and bleeding (Bleeding Academic Research Consortium (BARC)) complications or net adverse clinical event (NACE). A major secondary endpoint was BARC Types 2, 3 or 5 bleeding. Outcomes were compared between ticagrelor and clopidogrel treated patients. Multivariable analyses were performed to elucidate predictors of complications.
Results: Twenty-seven of 152 patients discharged on TT were on ticagrelor. NACE occurred in 52% and BARC 2, 3 or 5 bleeding occurred in 18% of patients. There was no difference in the primary or secondary outcome between ticagrelor versus clopidogrel sub-group. On multiple logistic regressions (Figure 1 and 2), use of TT in patients with acute coronary syndrome (ACS) (p = 0.002) and bridging in with ticagrelor (p=0.02) was associated with increased NACE. Low eGFR was an independent predictor of bleeding (p = 0.03).
Conclusions: From our analysis ticagrelor was not found to be an independent predictor of higher bleeding in TT. Instead, low eGFR is associated with higher risk of bleeding. Use of bridging anticolagulation with ticagrelor is associated with higher NACE.
Author Disclosures: K. Singh: None. A. Fu: None. J. Abunassar: None. N. Malhotra: None. B. Hibbert: None. A.Y. Chong: None. D. So: None.
- © 2015 by American Heart Association, Inc.