Students Research in Progress
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Introduction: Evidence shows that dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor improves patient outcomes following certain vascular events and interventions. DAPT is also associated with increased risk of bleeding. Treatment guidelines have outlined specific indications and recommended treatment durations for DAPT to optimize benefit and minimize risk.
Research Question or Hypothesis: What is the rate of guideline concordance for DAPT in a geriatric population and what are the reasons for non-concordance?
Study Design: Observational, retrospective chart review
Methods: Patients >65 years who were on DAPT and were seen in one of two Nebraska Medicine PCMH clinics between 12/01/2021 and 05/23/2023 were included in the study. Retrospective data on demographics, diagnoses, medications, and laboratory results were collected from patients’ electronic health records. Descriptive statistics were used to analyze prescribing patterns and concordance with DAPT guidelines based on indication, duration of therapy, medication dose, and bleeding risk (PRECISE-DAPT score).
Results: The total number of participants in this study was 348. The mean age was 76 years and 51.7% were male. Overall concordance with DAPT guidelines was 20.4% (N=71). Of the 277 nonconcordant patients,18 (6.5%) lacked a guideline-driven indication and 259 (93.5%) had a duration of therapy that exceeded recommendations. In addition, many patients treated with DAPT outside the guidelines had an increased risk of bleeding. Of the nonconcordant patients 63 (22.7%) had concurrent medication(s) that increase bleeding risk, 143 (51.6%) had a PRECISE-DAPT score >25, and 20 (7.2%) had a known bleeding disorder.
Conclusion: This study found that a large majority of study patients were on DAPT beyond the guideline-based recommendations for duration of therapy based on indication. Among these patients, over 50% had an increased risk of bleeding.
Presenting Author
Raeanne Whitcomb BS Biology, MS Health ScienceUniversity of Nebraska Medical Center
Authors
Donald G. Klepser PhD, MA
UNMC COP
Linda Sobeski PharmD
UNMC COP