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Number of Antithrombotic Drugs Used Early and In-hospital Outcomes in Acute Coronary Syndromes

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Abstract

Antithrombotic drug use for acute coronary syndromes (ACS) varies considerably. The number of antithrombotic drugs (excluding oral anticoagulants) used pre- and in-hospital was recorded in ACS survivors enrolled at hospital discharge in the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) registry (NCT01171404), a prospective cohort study. Among 10,568 patients, the number of antithrombotic drugs used early/patient ranged from 0 to 8 (interquartile range = 3–4). Overall, 250 patients (2.4%) experienced ≥ 1 in-hospital ischemic event and 343 (3.2%) ≥ 1 non-fatal bleeding event. While there was no difference in the rate of ischemic events (p = 0.75 for-trend) according to the number of antithrombotic drugs, a significantly higher incidence of non-fatal bleeds was observed (p < 0.0001 for-trend), with OR = 1.68 (95%CI = 1.51–1.88) per additional antithrombotic drug, which remained after adjustment by patient characteristics. In conclusion, careful balancing of the short-term risks for ischemic and bleeding events should be considered when adding new antithrombotic drugs.

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Abbreviations

ACS:

Acute coronary syndromes

EPICOR:

Long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients

LMWH:

Low molecular weight heparin

NSTEMI:

Non-ST-segment elevation myocardial infarction

STEMI:

ST-segment elevation myocardial infarction

UFH:

Unfractionated heparin

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Acknowledgments

XR has received support from the SEC-CNIC CARDIOJOVEN fellowship programme. Medical writing support was provided by Paragon, Knutsford, UK, in accordance with Good Publication Practice guidelines.

Funding

This study was funded by AstraZeneca (no grant number available). Support from the funder included development of the study design, collection and analysis of data, and provision of medical writing support during manuscript development. Being a non-interventional study, no drugs were supplied or funded.

Author information

Authors and Affiliations

  1. Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain

    Roberto Martín-Asenjo & Héctor Bueno

  2. Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK

    John Gregson, Xavier Rossello & Stuart Pocock

  3. Cardiology Department, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain

    Xavier Rossello

  4. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernandez Almagro, 3, 28029, Madrid, Spain

    Xavier Rossello, Stuart Pocock & Héctor Bueno

  5. Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium

    Frans Van de Werf

  6. Global Medical Affairs, AstraZeneca, Madrid, Spain

    Jesús Medina

  7. Hôpital Européen Georges Pompidou & René Descartes University, Paris, France

    Nicolas Danchin

  8. Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Madrid, Spain

    Héctor Bueno

  9. Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain

    Héctor Bueno

Authors
  1. Roberto Martín-Asenjo
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  2. John Gregson
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  3. Xavier Rossello
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  4. Frans Van de Werf
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  5. Jesús Medina
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  6. Nicolas Danchin
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  7. Stuart Pocock
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  8. Héctor Bueno
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Contributions

RMA and HB worked on conception of the study; JG, SP, and XR made the statistical analyses; RMA, SP, and HB contributed to the analysis and interpretation of the data; RMA and HB drafted the paper; RMA, JG, XR, FVdW, JM, ND, SP, and HB worked on further drafting and revising the paper critically. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Héctor Bueno.

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Ethical Standards

No animal studies were carried out by the authors for this article. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

RMA has received consulting fees from AstraZeneca and Bayer, and speaking fees or support for attending scientific meetings from Daichii-Sankyo, Bayer, and Cardiome. JG has received grants from AstraZeneca during the conduct of the study and outside of the submitted work. XR has nothing to disclose. FVdW has received consulting fees and research grants from Boehringer Ingelheim and Merck, and consulting fees from Roche, Sanofi Aventis, AstraZeneca, and The Medicines Company. JM is an employee of AstraZeneca. ND has received consulting or speaking fees from Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, GlaxoSmithKline, Intercept, MSD, Novartis, Novo-Nordisk, Pfizer, Sanofi, and Servier. SP has received research grant support from AstraZeneca. HB has received research funding from the Instituto de Salud Carlos III (PIE16/00021), AstraZeneca, BMS, Janssen, and Novartis; consulting fees from Abbott, AstraZeneca, Bayer, BMS-Pfizer, and Novartis; and speaking fees or support for attending scientific meetings from AstraZeneca, Bayer, BMS-Pfizer, Ferrer, Novartis, Servier, and MEDSCAPE-the heart.org.

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Associate Editor Paul J. R. Barton oversaw the review of this article

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Martín-Asenjo, R., Gregson, J., Rossello, X. et al. Number of Antithrombotic Drugs Used Early and In-hospital Outcomes in Acute Coronary Syndromes. J. of Cardiovasc. Trans. Res. 14, 790–798 (2021). https://doi.org/10.1007/s12265-020-10094-5

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