2. Insights from a Contemporary STEMI Prospective Registry
POSTER 1 7:10 – 7:17
Risk Profile and Impact of Pharmacological Thromboprophylaxis on Bleeding Event and Outcome:
Insights from a Contemporary STEMI Prospective Registry 
Presenter: Etienne L. Couture
Authors: Etienne L. Couture, Maxime Cerantola, Paul Farand, Simon Bérubé, Karl Dalery, André Gervais, Richard Harvey, Michel Nguyen, Benoit Daneault. Département de cardiologie, Centre Hospitalier Universitaire de Sherbrooke (CHUS) Université de Sherbrooke, Sherbrooke, Québec, Canada.

3. Risk Profile and Impact of Pharmacological Thromboprophylaxis on Bleeding Event and Outcome: Insights from a Contemporary STEMI Prospective Registry.
Fellows Poster Competition
Montreal Live Symposium 2016
Etienne L. Couture, Maxime Cerantola, Paul Farand, Simon Bérubé, Karl Dalery, André Gervais, Richard Harvey, Michel Nguyen, Benoit Daneault
Division de Cardiologie, Centre hospitalier universitaire de Sherbrooke (CHUS)
Université de Sherbrooke, Sherbrooke, Québec, Canada

4. Research Question
In the modern reperfusion era, do we still need thromboprophylaxis in STEMI patients ?

5. Introduction
Before the revascularization era, STEMI was recognized as a high-risk factor for venous thromboembolism (VT)  Population excluded from pharmacological thromboprophylaxis (PT) studies.
CHEST Guidelines (2012) recommend use of the Padua score to stratify and guide PT use in medical patients
Contemporary treatments including PPCI, early ambulation and potent dual antiplatelet therapy (DAPT) may have lowered this risk.
Kahn SR et al. CHEST 2012; 141(2)(Suppl):e195S–e226S
Barbar S et al. J Thromb Haemost 2010; 8: 2450–7.

6. Padua Risk Score
Barbar S et al. J Thromb Haemost 2010; 8: 2450–7.

7. Methods Design: Retrospective study (medical chart review)
Population: Consecutive patients treated with PPCI between January 2012 and December 2013 in our institution (N=650)
Exclusion criteria: anticoagulation / no f-up > 90 days.
Data collected: Padua score, PT status and VT at 90 days
Analysis
- Appropriate use of PT in low and high-risk Padua score was evaluated 
- Bleeding/ischemic outcomes and VT versus PT status
Ethical Approval: Centre de Recherche du CHUS

8. Clinical and Procedural Characteristics According to the Thromboprophylaxis Status
No Pharmacological Thromboprophylaxis (n=240)
Pharmacological Thromboprophylaxis (n=261)
P value
Baseline characteristics
Age
62±12
64±12
0.200
Male
182 (76%)
195 (75%)
0.836
Diabetes
40 (17%)
52 (20%)
0.358
Hypertension
110 (46%)
115 (44%)
0.720
Current smoking
161 (67%)
164 (63%)
0.349
Dyslipidemia
240 (100%)
257 (99%)
0.125
Previous revascularization
34 (14%)
29 (11%)
0.346
Previous stroke
8 (3.3%)
8 (3.1%)
1.000
Cardiogenic shock
18 (8%)
20 (7%)
0.950
Duration of hospitalization, days
2.7±1.6
3.7±3.2
0.010
Procedural characterisitics
Radial access artery
Bivalirudine
177 (74%)
176 (67%)
0.141
Gp2b3a inhibitors
54 (21%)
0.255
Clopidogrel
43 (18%)
58 (22%)
0.265
Prasugrel
53 (22%)
51 (20%)
0.509
Ticagrelor
134 (56%)
150 (58%)
0.719

9. Padua Risk Profile According to PT Status
No Pharmacological Thromboprophylaxis (n=240)
Pharmacological Thromboprophylaxis
(n=261)
P value
Padua score ≥ 4
18 (8%)
34 (13%)
0.040
Active cancer
Previous VTE
4 (1.7%)
8 (3.1%)
0.387
Reduced mobility
18 (7.5%)
20 (7.7%)
1.000
Already known thrombophilic condition
0 (0%)
1 (0.4%)
Recent (<1 month) trauma and/or surgery
Elderly age (>70 years)
59 (25%)
74 (28%)
0.363
Heart and/or respiratory failure
52 (22%)
85 (33%)
0.007
Acute myocardial infarction or ischemic stroke
240 (100%)
2610 (100%)
Acute infection and/or rheumatologic disorder
5 (0%)
8 (1.1%)
0.250
Obesity (BMI > 30)
55 (23%)
52 (20%)
0.446
Ongoing hormonal treatment

10. Thromboembolic, bleeding and ischemic outcomes according to PT status.
No Pharmacological Thromboprophylaxis (n=240)
Pharmacological Thromboprophylaxis (n=261)
P value
Venous thromboembolism at 90 days
Bleeding events
Transfusion
ACUITY bleeding
TIMI minor
TIMI major
Ischemic events
In-hospital death
Mortality at 30 days
Total
Cardiovascular
Early STEMI at 30 days
Stroke at 30 days
0 (0%)
4 (1.7%)
7 (3%)
4 (2%)
11 (5%)
12 (5%)
10 (4%)
3 (1%)
1 (0.4%)
21 (8%)
2 (1%)
8 (3%)
5 (2%)
1.000
0.200
0.010
0.150
0.170
0.400
0.500
0.140
0.900

11. Padua Risk Score Distribution

12. Pharmacological Thromboprophylaxis According to the Padua Risk Score

13. Conclusion VT is rare in STEMI patients treated with PPCI and DAPT
PT is potentially associated with an increased rate of ACUITY bleeding
In the PPCI era, most STEMI patients should not routinely receive PT

14. Thank You

15. Back-up Slide Padua Risk Score
37 VT events
2/37 had MI or stroke
Barbar S et al. J Thromb Haemost 2010; 8: 2450–7.

16. Back-up Slide Padua Risk Score
Barbar S et al. J Thromb Haemost 2010; 8: 2450–7.