Encore Presentations
Tuesday, November 14, 2023
08:30 AM–10:00 AM
Abstract
Rationale: The introduction of antiretroviral therapy (ART) has allowed people living with HIV/AIDS (PLWHA) to lead nearly normal lives, however literature indicates HIV is an independent risk factor for cardiovascular complications, such as myocardial infarction (MI). Many experts suggest prasugrel as the preferred P2Y12 inhibitor post-percutaneous coronary intervention (PCI) for PLWHA on boosted ART due to drug-drug interaction, however there are minimal long-term clinical data to support this.
Objective: To evaluate clinical outcomes (i.e., cardiovascular and bleeding events) associated with P2Y12 inhibitors in PLWHA on boosted antiretrovirals (containing ritonavir or cobicistat) within one-year post-PCI.
Methods: This was a multicenter descriptive retrospective cohort study of adult PLWHA who received boosted antiretroviral and P2Y12 inhibitor therapies post-PCI over four hospitals. The primary outcome was ischemic event [e.g., acute coronary syndrome (ACS), ischemic stroke (CVA), transient ischemic attack (TIA)] or cardiovascular death within one-year post-PCI. Secondary outcomes included clinically relevant bleeding within one-year post-PCI. All outcomes were adjudicated by two physicians.
Results: Baseline characteristics and clinical outcomes were presented as descriptive statistics. Of 47 identified patients, 24 were analyzed as all 24 were discharged on aspirin and clopidogrel post-PCI with no utilization of prasugrel or ticagrelor. The mean age was 58 ± 7.3 years, 19 (79%) presented with ACS, and 16 (67%) were on boosted protease inhibitor ART. Three patients (13%) experienced the primary outcome (1 MI, 1 CVA, 1 TIA), and 1 (4%) experienced in-stent restenosis within one-year post-PCI. No clinically relevant bleeding events were recorded within one-year post-PCI.
Conclusion: In this small cohort, PLWHA on boosted ART and clopidogrel had few recorded cardiovascular events within one year post-PCI. Larger studies are needed to confirm these findings and explore outcomes with prasugrel post-PCI in PLWHA on boosted ART. If a contraindication to prasugrel exists, clopidogrel may be an acceptable alternative in this subpopulation.
Presenting Author
Stanley Luc Pharm.D.Memorial Healthcare System
Authors
Joseph McKeown D.O.
Broward Health Medical Center
Lee Phan D.O.
Broward Health Medical Center
Francis Zamora Pharm.D.
Hunterdon Medical Center