{
  "abstract": "Background The European Society of Cardiology recommends a risk-stratified approach for selecting second antiplatelet therapy following non-ST elevation acute coronary syndrome (NSTEACS). Patients admitted to our district hospital with NSTEACS are transferred to a PCI centre and then returned for ongoing care. However, many are discharged on an inappropriate second antiplatelet agent due to unclear guidance on prescribing and bleeding risk assessment, potentially leading to worse outcomes and higher bleeding risk.Aim To improve the discharge rate of NSTEACS patients on the correct second antiplatelet therapy after ‘treat and return’ PCI.Methods We retrospectively reviewed NSTEACS patients discharged after PCI in the six months prior to the intervention, assessing bleeding risk (CRUSADE score) and appropriateness of second antiplatelet therapy. In collaboration with the PCI centre, we established criteria for prasugrel use (CRUSADE score ≤40) and clopidogrel for higher scores or medically managed patients. A proforma with a flowchart was created to guide resident doctors in prescribing ( figure 1). Data from three months after the intervention were reviewed to assess impact.Results In the six months prior to the intervention, 30 patients were discharged, with only 8 (26.7%) receiving the correct second antiplatelet. After the intervention, 20 patients were treated at the PCI centre, and 18 (90%) had the proforma completed. All patients with completed proforma had the CRUSADE score correctly calculated, and 100% were discharged on the appropriate second antiplatelet (a 73.3% improvement). Resident feedback highlighted the proforma’s ease of use and its effectiveness in guiding antiplatelet choice.Conclusions This simple, cost-effective intervention significantly improved appropriate second antiplatelet prescribing, contributing to better long-term patient outcomes.Abstract 265 Figure 1Flowchart created to assist resident doctors reviewing patients post percutaneous coronary intervention in making decisions about which second antiplatelet to prescribe",
  "authors": [
    {
      "affiliations": [
        "Homerton Healthcare NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Tom Alexander Rayner"
    },
    {
      "affiliations": [
        "Homerton Healthcare NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Meher Lehri"
    },
    {
      "affiliations": [
        "Homerton Healthcare NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Anantharaman Ramasamy"
    }
  ],
  "title": "265 Enhancing antiplatelet therapy following ‘treat and return’ PCI: a quality improvement initiative to optimize patient outcomes",
  "uid": "621fd1fb-b51b-58be-bdee-d8dae6e8497e"
}