Abstract 4145424: 30-Day Outcomes of Dual vs Triple Antithrombotic Therapy After PCI

Introduction: Dual therapy with clopidogrel and an anticoagulant has become the standard of care for patients on long-term anticoagulation following PCI. However, the impact of initial triple therapy and the selection of optimal P2Y12 inhibitor on ischemic and bleeding events is ambiguous during the first 30 days after PCI. Aim: Explore prescribing patterns and outcomes of patients discharged on dual therapy versus triple therapy post PCI. Methods: We performed a retrospective chart review of all patients receiving PCI at a single institution over a 12-month time frame who were discharged on an anticoagulant. The exposure variable was type of therapy (dual vs. triple) prescribed at discharge as well as anticoagulants and P2Y12 inhibitors prescribed. The outcome was any 30-day event defined as death, stent thrombosis, major bleeding events, and composites of ischemic and bleeding events. Differences were explored using Fisher’s exact test due to the low number of types of events. Results: The study included 124 patients. 41% patients were treated with immediate dual therapy, and 59% were discharged on triple therapy. A greater proportion of patients undergoing non-elective PCI received triple combination therapy (58% vs 31%; P=0.004; Table 1). There was no statistically significant difference in death or composite outcomes between groups (Table 2). Two stent thrombosis events occurred, both in patients receiving dual antithrombotic therapy with clopidogrel ( P=0.09 ). No stent thrombosis events occurred in patients initially started on triple therapy or in patients receiving dual therapy utilizing a more potent P2Y12 inhibitor. Four major bleeding events were noted in patients on triple therapy, and 1 major bleeding event occurred in a patient on dual therapy ( P=0.31 ; Table 2). Conclusion: In this retrospective analysis of patients, a trend toward higher albeit not statistically significant 30-day stent thrombosis event rate was noted in patients started on dual therapy using clopidogrel for P2Y12 inhibition. These findings should be cautiously interpreted, and analysis is ongoing in a larger dataset to better define the relationship between type of therapy and ischemic and bleeding events.