RT Journal Article
SR Electronic
T1 36 Triple Therapy Anticoagulation following Percutaneous Coronary Intervention (PCI) with Novel Oral Anticoagulants (NOAC) is Safe and has no Adverse Effects on Bleeding Post Procedure when Compared to Triple Therapy with Vitamin K Antagonist (VKA)
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP A25
OP A26
DO 10.1136/heartjnl-2016-309890.36
VO 102
IS Suppl 6
A1 Reshma Amin
A1 Nicholas McWilliams
A1 Deacon Lee
A1 Fatima Altaf
A1 Farzana Virani
A1 Katherine Dickinson
A1 David Walker
A1 Andrew Sharp
A1 Robert Gerber
YR 2016
UL http://heart.bmj.com/content/102/Suppl_6/A25.abstract
AB Introduction Following PCI, dual antiplatelet therapy (DAPT) is indicated for prevention of stent thrombosis.An increasing number of patients also require long term oral anticoagulation for stroke prevention in atrial fibrillation, for mechanical heart valves and venous thromboembolism.Bleeding rates are historically higher in patients on triple therapy anticoagulation when compared to those on DAPT.Since the introduction of NOAC, there are a variety of combinations of triple therapy anticoagulation that patients can be commenced on following PCI; however the bleeding risks between these groups are yet to be compared.Abstract 36 Figure 1 Bleeding (TIMI & BARC) and MACCE in patients receiving triple therapy (with VKA vs NOAC) following PCIMethods We retrospectively studied 853 patients who underwent PCI in one centre from 2013–2014.Of these, 103 patients required triple therapy, 49 with a Vitamin K antagonist (VKA) and 54 with NOAC.The primary endpoint was 12 month bleeding complications as categorised by the Bleeding Academic Research Consortium (BARC). The secondary endpoint was major adverse cardiovascular and cardiac events (MACCE).Results Of those on Triple Therapy Anticoagulation, 69% of patients were male and 32% were aged 75 or above.The indications for anticoagulation were AF (74%), Venous Thromboembolism (12%), left ventricular thrombus (13%) and mechanical heart valve (1%)Of those anticoagulated for AF, 95% had a CHA2ds2-VASc score greater than 2.29% of PCI was performed for NSTEACS and 17% for ST segment elevation MI.In the VKA category there was 12% minor bleeding compared to 22% in NOAC group (p0.0419).There was no significant difference between TIMI Major and BARC bleeding between the two groups.MACCE in the VKA group was 12% and in the NOAC group 5% of which. (p = 0.0412)Conclusion There is no significant difference in the bleeding risk between patients taking triple therapy anticoagulation following PCI with a NOAC or a VKA.Patients requiring triple therapy anticoagulation following PCI have significantly less risk of MACCE at 12 month follow up with NOAC compared to VKA.