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.

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

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

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.

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

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

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

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

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

Padua Risk Score Distribution

Pharmacological Thromboprophylaxis According to the Padua Risk Score

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

Thank You

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.

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