Antithrombotic therapy in patients with acute coronary syndrome in the intermountain heart collaborative study
Stacey Knight1, Winslow Klaskala2, Scott C Woller1
1Intermountain Medical Center, Intermountain Heart Institute, 5121 S. Cottonwood Street, Murray, UT 84107, USA ; University of Utah School of Medicine, Salt Lake City, UT 84108, USA.
Insights
In hospital, acute coronary syndrome (ACS) patients received anticoagulants (AC) and dual antiplatelet therapy (DAP) frequently. Post-discharge, AC use decreased significantly, with stent placement predicting DAP use.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Acute coronary syndrome (ACS) management involves complex antithrombotic strategies.
- Balancing efficacy and bleeding risk is crucial in selecting antiplatelet (AP) and anticoagulant (AC) therapies.
Purpose of the Study:
- To identify factors influencing the use of single antiplatelet (SAP), dual antiplatelet (DAP), and anticoagulant (AC) therapy in ACS patients.
- To analyze in-hospital and post-discharge treatment patterns for antithrombotic agents.
Main Methods:
- Analysis of 5,294 ACS patients from the Intermountain Heart Collaborative Study (2004-2009).
- Multivariable logistic regression models were employed to determine predictors of AC and AP use.
- Evaluation of treatment patterns based on patient characteristics and interventions like stenting.
Main Results:
- In-hospital: 99% received AC, 79% DAP, 19% SAP; 78% had DAP + AC. Coronary stents strongly predicted DAP use.
- Post-discharge: 77% received DAP, 20% SAP, 9% AC; 5% had DAP + AC.
- Patients with atrial fibrillation or venous thromboembolism history showed increased AC use (29% and 40%, respectively).
Conclusions:
- In-hospital AC use was nearly universal, but post-discharge AC use was infrequent.
- Stent placement significantly increased the likelihood of DAP therapy.
- Treatment decisions appear influenced by the need for effective antithrombotic therapy while mitigating bleeding risk.
Abstract:
Objective. To determine factors associated with single antiplatelet (SAP) or dual antiplatelet (DAP) therapy and anticoagulants (AC) use in hospital and after discharge among patients with acute coronary syndrome (ACS). Methods. We evaluated 5,294 ACS patients in the Intermountain Heart Collaborative Study from 2004 to 2009. Multivariable logistic regressions were used to determine predictors of AC or AP use. Results. In hospital, 99% received an AC, 79% DAP, and 19% SAP; 78% had DAP + AC. Coronary stents were the strongest predictors of DAP use in hospital compared to SAP (P < 0.001). After discharge, 77% received DAP, 20% SAP, and 9% AC; 5% had DAP + AC. DAP compared to SAP was less likely for patients on AC (odds ratio [OR] = 0.30, P < 0.0001) after discharge. Placement of a stent increased the likelihood of DAP (bare metal: OR = 54.8, P < 0.0001; drug eluting: OR = 59.4, P < 0.0001). 923 had atrial fibrillation and 337 had a history of venous thromboembolism; these patients had increased use of AC (29% and 40%, resp.). Conclusion. While in-hospital use of AC was nearly universal, postdischarge AC use was rare. Concern for providing the best antithrombotic therapy, while maintaining an acceptable bleeding risk, may explain the selection decisions.
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