Login Register Cart 0
Generic placeholder image

Current Vascular Pharmacology

Editor-in-Chief

ISSN (Print): 1570-1611
ISSN (Online): 1875-6212

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Clinical Trial

Long-Term Outcome of Acute Coronary Syndromes in Patients on Chronic Oral Anticoagulants: Data from the EPICOR Study

Author(s): Janina Stepinska*, Izabela Wojtkowska, Lieven Annemans, Nicolas Danchin, Stuart J. Pocock, Frans Van de Werf, Jesús Medina and Hector Bueno

Volume 18, Issue 1, 2020

Page: [92 - 99] Pages: 8

DOI: 10.2174/1570161117666181227122355

Price: $65

Abstract

Objective: To analyze characteristics, management and outcomes of patients with acute coronary syndromes (ACS) receiving chronic oral anticoagulant (OAC) therapy enrolled in the EPICOR (long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients) prospective, international, observational study of antithrombotic management patterns in ACS survivors (NCT01171404).

Methods: This post-hoc analysis evaluated the association between OAC use at baseline (OACb) and time from hospital admission to percutaneous coronary intervention (PCI) (tHA-PCI), pre-PCI thrombolysis in myocardial infarction (TIMI) 3 flow, stent type, length of hospitalization, and clinical endpoints; death, non-fatal MI, and non-fatal stroke, a composite of these ± bleeding, over 2 years’ follow-up.

Results: Of 10,568 ACS patients, 345 (3.3%) were on OACb (non-ST-segment elevation ACS [NSTEACS], n=268; ST-segment elevation MI [STEMI], n=77). OACb patients were older with more comorbidities. In NSTE-ACS OACb patients, tHA-PCI was longer (median 57.4 vs. 27.8 h; p=.008), and TIMI 3 flow rarer (26.0 vs. 33.5%; p=0.035). OACb patients had longer mean hospital stay (NSTEACS: 8.9 vs. 7.6 days; p<0.001; STEMI: 9.5 vs. 7.8 days; p=0.015), and higher rates of the composite endpoint (NSTE-ACS: 16.8 vs. 8.8%; p<0.0001; STEMI: 23.4 vs. 5.9%; p<0.0001). Bleeding events were more common with OACb (NSTE-ACS: 6.0 vs. 3.3%; p=0.01; STEMI: 6.5 vs. 2.8%; p=0.04).

Conclusion: At 2-years, OACb use was associated with an increased risk of cardiovascular and bleeding events in STEMI and NSTE-ACS. NSTE-ACS patients on OACb experienced prolonged time to intervention, lower rates of TIMI 3 flow and longer hospitalization.

Keywords: Acute coronary syndrome, oral anticoagulant, EPICOR, PCI, OAC, DAPT.

« Previous
Graphical Abstract

[1]
Rubboli A, Faxon DP, Juhani Airaksinen KE, et al. The optimal management of patients on oral anticoagulation undergoing coronary artery stenting. The 10th Anniversary Overview. Thromb Haemost 2014; 112: 1080-7.
[2]
Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37: 2893-962.
[3]
Roffi M, Patrono C, Collet JP, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2016; 37: 267-315.
[4]
Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibrillation: The task force for the management of atrial fibrillation of the European society of cardiology (ESC). Eur Heart J 2010; 31: 2369-429.
[5]
Oudot A, Steg PG, Danchin N, et al. Impact of chronic oral anticoagulation on management and outcomes of patients with acute myocardial infarction: Data from the RICO survey. Heart 2006; 92: 1077-83.
[6]
Secemsky EA, Butala NM, Kartoun U, et al. Use of chronic oral anticoagulation and associated outcomes among patients undergoing percutaneous coronary intervention. J Am Heart Assoc 2016; 5pii: e004310
[7]
Bueno H, Danchin N, Tafalla M, Bernaud C, Annemans L, Van de Werf F. EPICOR (long-term follow-up of antithrombotic management patterns in acute coronary syndrome patients) study: Rationale, design, and baseline characteristics. Am Heart J 2013; 165: 8-14.
[8]
Bueno H, Pocock S, Danchin N, et al. International patterns of dual antiplatelet therapy duration after acute coronary syndromes. Heart 2017; 103: 132-8.
[9]
Heidbuchel H, Verhamme P, Alings M, et al. European Heart Rhythm Association practical guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013; 15: 625-51.
[10]
Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet 2013; 381: 1107-15.
[11]
Lip GY, Windecker S, Huber K, et al. Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European society of cardiology working group on thrombosis, European heart rhythm association (EHRA), European association of percutaneous cardiovascular interventions (EAPCI) and European association of acute cardiac care (ACCA) endorsed by the heart rhythm society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS). Eur Heart J 2014; 35: 3155-79.
[12]
D’Ascenzo F, Taha S, Moretti C, et al. Meta-analysis of randomized controlled trials and adjusted observational results of use of clopidogrel, aspirin, and oral anticoagulants in patients undergoing percutaneous coronary intervention. Am J Cardiol 2015; 115: 1185-93.
[13]
Gao XF, Chen Y, Fan ZG, et al. Antithrombotic regimens for patients taking oral anticoagulation after coronary intervention: A meta-analysis of 16 clinical trials and 9,185 patients. Clin Cardiol 2015; 38: 499-509.
[14]
Heidbuchel H, Verhamme P, Alings M, et al. Updated European heart rhythm association practical guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 2015; 17: 1467-507.
[15]
Potpara TS, Lip GY, Dagres N, Estner HL, Larsen TB, Blomstrom-Lundqvist C. Management of acute coronary syndrome in patients with non-valvular atrial fibrillation: Results of the European Heart Rhythm Association survey. Europace 2014; 16: 293-8.
[16]
Asencio LA, Huang JJ, Alpert JS. Combining antiplatelet and antithrombotic therapy (triple therapy): What are the risks and benefits? Am J Med 2014; 127: 579-85.
[17]
Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS: The task force for the management of atrial fibrillation of the European society of cardiology (ESC) developed with the special contribution of the European heart rhythm association (EHRA) of the ESC endorsed by the European stroke organization (ESO). Eur Heart J 2016; 37: 2893-962.
[18]
Steg PG, James SK, Atar D, et al. ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33: 2569-619.
[19]
Bueno H, Sinnaeve P, Annemans L, et al. Opportunities for improvement in anti-thrombotic therapy and other strategies for the management of acute coronary syndromes: Insights from EPICOR, an international study of current practice patterns. Eur Heart J Acute Cardiovasc Care 2016; 5: 3-12.
[20]
Rubboli A, Saia F, Sciahbasi A, et al. Outcome of patients on oral anticoagulation undergoing coronary artery stenting: Data from discharge to 12 months in the Warfarin and Coronary Stenting (WAR-STENT) registry. J Invasive Cardiol 2014; 26: 563-9.
[21]
Caballero L, Ruiz-Nodar JM, Marin F, et al. Oral anticoagulation improves the prognosis of octogenarian patients with atrial fibrillation undergoing percutaneous coronary intervention and stenting. Age Ageing 2013; 42: 70-5.
[22]
Gibson CM, Mehran R, Bode C, et al. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med 2016; 375: 2423-34.
[23]
Cannon CP, Bhatt DL, Oldgren J, et al. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med 2017; 377: 1513-24.

Rights & Permissions Print Cite
Article Metrics
33
© 2024 Bentham Science Publishers | Privacy Policy