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Bleeding risk in patients with NSTEMI: P2Y12 inhibitors prescription patterns from 2019 to 2021
Session:
Posters (Sessão 2 - Écran 6) - DAC e Cuidados Intensivos 3 - SCAsST
Speaker:
Diogo Santos Da Cunha
Congress:
CPC 2022
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Diogo Santos da Cunha; Gonçalo j. Morgado; Mariana Martinho; Bárbara Ferreira; João Grade Santos; Alexandra Briosa; Ana Rita Pereira; Rita Calé; Cristina Martins; Hélder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In the <em>“2020 Acute Coronary Syndromes (ACS) in Patients Presenting without Persistent ST-Segment Elevation Guidelines</em>” the European Society of Cardiology presented the <em>Academic Research Consortium for High Bleeding Risk (ARC-HBR)</em> criteria in order to help clinicians choose between antithrombotic strategies (<em>clopidogrel</em> for HBR patients or <em>ticagrelor</em> for non-HBR patients, in addition to aspirin). Regarding this fact, we conducted a retrospective study to analyze prescription patterns regarding P2Y12 inhibitors and its accordance to the criteria.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We analyzed the ARC-HBR criteria and the antithrombotic strategy chosen at time of discharge for patients with NSTEMI-ACS undergoing PCI in the first six months of 2019 (n<sub>2019</sub>=67) and in the same period of 2021 (n<sub>2021</sub>=67), after excluding patients with indication for anticoagulation. Among the total of 134 patients, 46 (34.33%) had HBR; among these, 13 (28.26%) received ticagrelor despite guidelines’ indications, but no significant difference was identified between the two semesters. On the contrary, 88 patients (65.67%) had low bleeding risk (LBR), 11.36% of which received clopidogrel (10 patients), contradicting the recommendations, again with no difference between 2019 and 2021. The identified reasons not to follow the guidelines were 1) high ischemic risk – either by complex coronary anatomy or infarction under aspirin plus clopidogrel -, regarding ticagrelor in HBR patients; 2) poor adhesion to treatment and 3) low patient income, regarding clopidogrel in LBR patients. Within the group with no identifiable reasons in 2019 and 2021, there were also more HBR patients receiving ticagrelor than LBR patients receiving clopidogrel, which was seen likewise in the semesters separately. Besides, we noted that among the criteria, GRF (80%), age (80%), and hemoglobin (Hb) level (30%) were frequently not regarded by the clinician as justifiable criteria for a less potent therapy.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We concluded that 1) clinicians were more permissive when the possibility of giving a high potency P2Y12i was at stake; 2) the pattern of P2Y12i prescription was similar in 2019 and 2021; 3) apart from <em>Age, GFR, Hb level</em>, all other criteria seem to be subjectively well identified by professionals, which means the “clinical sense” of hemorrhagic risk was already somewhat accurate; 4) it seems consistent that, whether professionals use their clinical sense or the criteria, a few clinical features <em>(Age, GFR, Hb level)</em> are consistently less considered. </span></span></p>
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