Objective: To analyse 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).
Method: 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 hospitalisation, 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 [NSTE-ACS], 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 (NSTE-ACS: 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 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
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