Use of Contraindicated Antiplatelet Medications in the Setting of Percutaneous Coronary Intervention

Abstract

Background Several antiplatelet medications used during and after percutaneous coronary intervention (PCI) are contraindicated for specific patient groups. A broad assessment of contraindicated medication use and associated clinical outcomes is not well described. Methods and Results Using national VA CART Program data for all PCI between 2007-2013, we evaluated patients with contraindications to commonly used antiplatelet medications during and after PCI, defined in accordance with package inserts. Adjusted association between contraindicated medication use and outcomes of periprocedural bleeding and 30-day mortality were assessed using Cox proportional hazards with inverse probability weighting. Among 64,294 patients undergoing PCI, 11,315(17.6%) had a contraindication to a common antiplatelet medication and 737 (6.5%) of these patients received a contraindicated medication. In unadjusted analyses, any contraindicated medication use was associated with both increased bleeding and 30-day mortality. In adjusted models, contraindicated abciximab use in patients with thrombocytopenia (HR 2.23, 95% CI 1.58-3.16) and in patients with a prior stroke (HR 1.93, 95% CI 1.37-2.71) remained significantly associated with increased bleeding. Contraindicated abciximab use was not significantly associated with 30-day mortality in adjusted models. Use of eptifibatide in dialysis patients was not significantly associated with an increased risk of bleeding or mortality. Conclusions In this national cohort, about 18% of patients undergoing PCI had contraindications to common antiplatelet medications. Approximately 6% of those patients received a contraindicated medication with attendant bleeding risk, although this did not translate into significantly higher risk of 30-day mortality. Continued efforts to reduce contraindicated medication use may help avoid periprocedural complications.

Pulmonary embolism in patients with chronic coronary syndrome masquerading as acute coronary syndrome: a case report and literature review

“…Indeed, contraindications to antithrombotic therapy are not uncommon in thrombotic disorders. A national cohort study in the U.S. showed that antithrombotic therapy was contraindicated for up to 18% of patients who underwent percutaneous coronary intervention [ 23 ]. Variability in the clinical characteristics of patients results in different bleeding risks associated with antithrombotic therapy.…”

Comparative effectiveness and safety of antiplatelet drugs in patients with diabetes mellitus and acute coronary syndrome

“…The study period of each cohort began when the most recently marketed drug of the comparison became available (July 2009 for cohort 1 and October 2011 for cohorts 2 and 3) and ended on 30 September 2015. Prasugrel is contraindicated in patients with a history of stroke and is not indicated post ACS that was treated medically or led to CABG . Accordingly, we only included patients undergoing PCI with stenting without a history of stroke (ischemic or hemorrhagic) in cohorts including prasugrel (ie, in cohorts 1 and 3).…”