886 Thrombosis and antithrombotic therapy

886

Thrombosis and antithrombotic therapy

P4861 | BEDSIDE Association of 2B3A inhibition with new antiplatelet regimens in the setting of acute coronary syndromes: a meta-analysis of randomized controlled trials F. Beygui 1 , M. Agueznai 1 , V. Roule 1 , R. Sabatier 1 , T. Lognone 1 , A. BellemainAppaix 2 , J.P. Collet 2 , G. Montalescot 2 , P. Milliez 1 . 1 University Hospital of Caen, Department of Cardiology, Caen, France; 2 AP-HP - Hospital Pitie-Salpetriere, Paris, France

P4863 | BEDSIDE Maximal antiplatelet therapy with prasugrel and GP IIb/IIIa-receptor antagonists in ST-elevation myocardial infarctions is not associated with high acute bleeding rates in clinical practice H. Wienbergen, J. Schmucker, S. Seide, E. Fiehn, A. Fach, D. Garstka, R. Hambrecht. Heart Center Bremen - und Kreislaufforschung am Klinikum Links der Weser, Bremen, Germany Introduction: Prasugrel was superior to clopidogrel in preventing ischemic events in TRITON-TIMI 38, however an elevated bleeding rate was observed. We analyzed bleeding under prasugrel and GP IIb/IIIa-receptor Antagonists (GPAs) in ST-Elevation Myocardial Infarctions (STEMIs) in clinical practice. Methods: The Bremer STEMI Registry is a prospective registry of STEMIpatients. Data are collected in the Bremen heart center, which is exclusively responsible for 24-hours-PCI service in a large region in northwest Germany. In this heart center since 2010 patients with STEMIs without contraindications were treated with prasugrel. Results: Since 2010 1655 STEMI-patients were included. Of the patients treated with prasugrel (795 patients) 612 patients received additional GPAs (92% tirofiban, 8% abciximab). Patients with prasugrel and GPAs were younger and had less comorbidities than patients without this therapy. The hospital bleeding rate in patients with prasugrel and GPAs was 3.9% (1.8% TIMI major or TIMI minor bleeding, 2.1% TIMI minimal bleeding). 58% of the bleeding was localized at the punction site. A comparison with the standard therapy of the years 2008-2009, clopidogrel + GPAs, was performed. For comparability patients with prasugrel-contraindications (≥ 75 years,< 60kg, prior stroke/TIA) were excluded. No significant differences in bleeding were found between the groups (Table).

Forest plot for primary endpoint

Conclusions: The association of 2B3A inhibition with new highly active antiplatelet regimens leads to a homogenous increase in the risk of major bleeding but its effects on the ischemic events are different between the studies with thienopyridines and ticagrelor. This heterogeneity, found in both active and control arms, seems to result from differences in studie’s characteristics and not between drugs.

P4862 | BEDSIDE The characteristics of patients with a recent history of acute myocardial infarction and their antiplatelet therapy utilization pattern in the UK general practice Q. Zhang 1 , C. Zhao 1 , K. Jameson 2 , V. Ashton 3 , E. Chen 4 . 1 Merck Sharp & Dohme Corp., Whitehouse Station, United States of America; 2 Merck Sharp & Dohme Corp., Hoddesdon, United Kingdom; 3 University of Medicine and Dentistry of New Jersey, Piscataway, United States of America; 4 Merck Sharp & Dohme Corp., Rahway, United States of America Purpose: Patients with a recent history of acute myocardial infraction (MI) are at an increased risk for subsequent cardiovascular (CV) events. Dual antiplatelet therapy (DAT) of aspirin and P2Y12 antagonists such as clopidogrel, prasugrel, and ticagrelor are recommended by ESC guidelines (2012) for secondary prevention of CV events, especially in the first year post MI. This analysis assessed among patients in a UK general practice setting, their characteristics and utilization pattern of antiplatelet therapy following an MI. Methods: Using a UK general practice database, patients who had an acute MI event between 12/01/2009 and 11/30/2010 (index period) and aged ≥18 years at the time of MI were identified and retrospectively followed up for 2 years (up to 11/30/2012). The last MI event during the index period is classified as the index MI. Those patients with a history of any stroke or transient ischemic attack (TIA) prior to the index MI were excluded, due to heightened bleeding risk and contraindications to certain combination antiplatelet treatment. All selected patients had available medical records for at least 1 year prior to and 2 years following the index MI. MI, stroke and TIA history were evaluated through all the available medical records prior to the index MI. Other patient characteristics were assessed according to the records 1 year prior to the index MI. The aspirin and P2Y12 antagonists use was based on the prescription records of 1 year prior to and 2 years post index MI. Results: Among 5,422 patients (71% males, mean age 69 years [SD 12]) who met the selection criteria, 66% were