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Results of an international crowdsourcing survey on the treatment of non-ST segment elevation ACS patients at high-bleeding risk undergoing percutaneous intervention.

Bhatt, Deepak L.; Carlos Kaski, Juan; Delaney, Sean; Alasnag, Mirvat; Andreotti, Felicita; Angiolillo, Dominick J.; Ferro, Albert; Gorog, Diana A.; Lorenzatti, Alberto J.; Mamas, Mamas; McNeil, John; Nicolau, José C.; Gabriel Steg, Philippe; Tamargo, Juan; Tan, Doreen; Valgimigli, Marco

Results of an international crowdsourcing survey on the treatment of non-ST segment elevation ACS patients at high-bleeding risk undergoing percutaneous intervention. Thumbnail


Authors

Deepak L. Bhatt

Juan Carlos Kaski

Sean Delaney

Mirvat Alasnag

Felicita Andreotti

Dominick J. Angiolillo

Albert Ferro

Diana A. Gorog

Alberto J. Lorenzatti

John McNeil

José C. Nicolau

Philippe Gabriel Steg

Juan Tamargo

Doreen Tan

Marco Valgimigli



Abstract

AIMS: Choosing an antiplatelet strategy in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) at high bleeding risk (HBR), undergoing post-percutaneous coronary intervention (PCI), is complex. We used a unique open-source approach (crowdsourcing) to document if practices varied across a small, global cross-section of antiplatelet prescribers in the post-PCI setting. METHODS AND RESULTS: Five-hundred and fifty-nine professionals from 70 countries (the 'crowd') completed questionnaires containing single- or multi-option and free form questions regarding antiplatelet clinical practice in post-PCI NSTE-ACS patients at HBR. A threshold of 75% defined 'agreement'. There was strong agreement favouring monotherapy with either aspirin or a P2Y12 inhibitor following initial DAPT, within the first year (94%). No agreement was reached on the optimal duration of DAPT or choice of monotherapy: responses were in equipoise for shorter (=3 months, 51%) or longer (=6 months, 46%) duration, and monotherapy choice (45% aspirin; 53% P2Y12 inhibitor). Most respondents stated use of guideline-directed tools to assess risk, although clinical judgement was preferred by 32% for assessing bleeding risk and by 46% for thrombotic risk. CONCLUSION: The crowdsourcing methodology showed potential as a tool to assess current practice and variation on a global scale and to achieve a broad demographic representation. These preliminary results indicate a high degree of variation with respect to duration of DAPT, monotherapy drug of choice following DAPT and how thrombotic and bleeding risk are assessed. Further investigations should concentrate on interrogating practice variation between key demographic groups.

Acceptance Date May 5, 2021
Publication Date Aug 15, 2021
Publicly Available Date Mar 29, 2024
Journal International Journal of Cardiology
Print ISSN 0167-5273
Publisher Elsevier
Pages 1 - 8
DOI https://doi.org/10.1016/j.ijcard.2021.05.012
Publisher URL https://www.sciencedirect.com/science/article/pii/S016752732100824X