Triple Antithrombotic Therapy in Cardiac Patients Requiring Revascularization

Overview

Aim(s)/Objective(s) * To evaluate the safety and efficacy of triple antithrombotic therapy in patients taking DAPT of aspirin and a P2Y12 inhibitor in addition to either a NOAC or warfarin for the prevention of thromboembolic or acute coronary syndrome (ACS) events in patients with non-valvular atrial fibrillation (AF), history of coronary artery disease (CAD)/stent placement or recurrent ACS event. * To determine the Methodist Health System (MHS) prescribing practices and patterns in cardiac patients with a history of AF who are admitted for CAD or an ACS event requiring PCI. Hypothesis Primary Hypothesis Cardiac patients with a history of AF and an indication for long-term NOAC who are also prescribed DAPT following an ASC event or revascularization with stenting will demonstrate a significant difference in cardiovascular outcomes and major bleeding events when compared with warfarin-based triple therapy.

STUDY DESIGN * Multi-center, retrospective cohort chart review study design * Data will be collected on all triple therapy recipients who were discharged from a Methodist Health System (MHS) facility with prescriptions for a combination of aspirin, P2Y12 Inhibitor and an OAC of either a NOAC or warfarin between April 1, 2017 - April 1, 2018 * Patient list will be generated in EPIC * All data will be obtained from EPIC * All data will be collected retrospectively after the patient is discharged from the hospital * Data collection (planned completion date): May 2019 Study Inclusion Criteria: * 18 years or older * AF diagnosis * ICD10 for ACS, STEMI or NSTEMI * Discharged with triple therapy agents of aspirin, P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor), and OAC (warfarin, edoxaban, dabigatran, rivaroxaban, or apixaban) status post-stent Study Exclusion Criteria: * Patients less than 18 years of age * Prior intracranial bleeding prior to study start date * GI hemorrhage within 1 month prior to study start date * Major bleeding event with 1 month prior to study start date * Hemorrhage disorder * Stroke within 1 month prior to study start date * Cardiogenic shock during admission at start date * Contraindication to use of the study medications * Peptic ulcer in the prior 6 months prior to study start date * Thrombocytopenia (platelet concentration lower than 50×109/L) * Thrombolysis In Myocardial Infarction (TIMI) major bleeding in the prior 12 months of study start date * Pregnancy * History of DVT or PE currently on OAC