Abstract 4148148: Acute Myocardial Infarction outcomes in patients on single anticoagulation versus combined anticoagulation and antiplatelet therapy

Introduction: Current guidelines recommend single anticoagulation (AC) therapy over combined AC plus anti-platelet (AP) therapy in patients with established cardiovascular disease (CVD) and concomitant indication for AC. Data on the in-hospital outcomes of acute myocardial infarction (AMI) in patients on single versus combined therapy is scarce. Methods: The National Inpatient Sample was used to identify adult patients with established CVD on AC and a primary diagnosis of AMI between 2016 and 2020. Data was stratified between patients on single AC and patients on combined AC and AP therapy. In-hospital outcomes were compared after case-control matching for significant comorbidities. Results: A total of 122,975 patients admitted for AMI were included, of which 57,220 (46.5%) were previously on combined therapy. PCI rates were similar in both groups (34.9% vs 34.6%, P=0.247). After matching (15,140 patients in each group), combined therapy was associated with decreased odds of in-hospital mortality, discharge to skilled nursing facilities (SNF), increased odds of mechanical circulatory support (MCS) use, and similar odds of in-hospital cardiovascular and bleeding complications compared to patients on single AC therapy (Figure 1). Conclusion: Combined AC plus AP therapy was associated with decreased in-hospital mortality, increase MCS use, and less SNF discharges compared to patients on single AC therapy admitted for AMI. There was no difference in in-hospital cardiac or bleeding complications.