triple antithrombotic therapy in cardiac patients requiring revascularization

Conditions: Cardiac Disease

Summary: 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

Eligibility criteria:
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 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

Keywords: icd10 for acs, stemi or nstemi, atrial fibrillation