OBJECTIVES

: The current study aimed to study the clinical utilization of oral antiplatelets and anticoagulants in a single institution cohort of adult patients with acute coronary syndrome (ACS) in Hong Kong.

METHODS

: All ACS patients from the Prince of Wales Hospital were retrospectively reviewed and included from 1 January 2012 to 31 December 2018. Patients were followed up for up to 12 months since their index hospitalization day. The primary outcome was the incidence of composite of deaths, major adverse cardiovascular events (MACE), including myocardial infarction (MI), stroke (ischemic, hemorrhagic or stroke of uncertain causes) and all-cause mortality within the 12 months since the start of the antithrombotic treatment.

RESULTS

A total of 9501 patients were included in the study. Ticagrelor demonstrated better efficacy in reduction of incidence rate of major cardiovascular events (1-month MACE: OR=0.596, P=0.005, 95%CI: 0.414-0.859, 1-year MACE: OR=0.607, P=0.03, 95%CI: 0.437-0.843 and overall MACE: OR=0.446, P<0.001, 95%CI: 0.327-0.608). In particular, ticagrelor significantly reduced the recurrence of MI at 1-year time (OR=0.600, P=0.005, 95%CI: 0.420-0.857). In patients with ACS and concomitant atrial fibrillation without undergoing Percutaneous Coronary Intervention, apixaban was found to significantly reduce the incidence of overall MACE (OR=0.287, P=0.033, 95%CI:0.09-0.903) with a significant reduction in overall mortality as a composite of MACE (OR=0.102, P=0.001, 95%CI:0.026-0.399) without a significant increase in overall bleeding events in comparison to dual therapy with warfarin.

CONCLUSIONS

: In conclusion, dual antiplatelet therapy with ticagrelor was superior to clopidogrel in patients with ACS regardless history of PCI in terms of reducing major cardiovascular event at any time point and improving overall survival without a significant increase in overall bleeding. For anticoagulants, apixaban reduced overall major cardiovascular events and overall mortality rate significantly relative to warfarin for both dual and triple therapy without an increase in overall bleeding events.