(237) Transition From Intravenous to Oral P2Y12 Inhibitors Post-Surgical Bridging

Introduction: The duration of dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS) patients is typically one year. Cangrelor, an intravenous (IV) P2Y12 receptor inhibitor, offers a rapid onset of action and serves as an effective oral bridging agent in the pre- and post-operative setting. However, the transition to oral P2Y12 inhibition post-cangrelor cessation can be complicated by bleeding, oral intake status, and errors in transitioning P2Y12 inhibitor agents increasing the risk of thromboembolic events. This study aims to assess IV to oral P2Y12 antagonist transition patterns to develop ways to improve appropriate transitions at an academic medical center.

Methods: This single health system retrospective review included adult patients between 1 August 2018 and 30 September 2023. Patients were included if they had been on a P2Y12 inhibitor agent for ACS within the previous 12 months. Patients were excluded if they had not undergone percutaneous coronary intervention (PCI) for ACS, had cardiogenic shock, heart transplantation, or were more than 12 months past their PCI. The primary outcome was the incidence of death related to stent thrombosis.

Results: Ninety-two patients were evaluated, and fifty-five patients were included within the study. Thirty-one patients were transitioned to oral P2Y12 inhibitors appropriately, receiving both an appropriate initiation time and loading dose. Twenty-seven of these patients received ticagrelor as their oral agent. Twenty-four patients were inappropriately transitioned, with 4 patients not receiving loading doses, 10 patients having delayed initiations, and 7 patients having both occur. Of these patients, 14 received clopidogrel, and 1 prasugrel. All patients who received ticagrelor inappropriately had a reported incidence or concern for bleeding. No incidence of death related to stent thrombosis occurred.

Conclusions: No incidence of death related to stent thrombosis occurred in patients who received either appropriate or inappropriate post-surgical bridging. Updates of institutional protocols are in progress as a result of this review.