{
  "abstract": "Introduction ACS is often seen in patients with an existing requirement for OAC therapy, for instance in those with atrial fibrillation (AF). In these circumstances, the European Society of Cardiology (ESC) guidelines recommend a specific treatment pathway to balance ischaemic risk against bleeding risk1. This strategy initiates triple anti-thrombotic therapy (TAT) for one week after occurrence of ACS, consisting of dual anti-platelet therapy (aspirin and a P2Y12 inhibitor) and a non-vitamin K antagonist OAC. In this patient population, clopidogrel is the P2Y12 inhibitor of choice given the significantly lower risk of major bleeding events compared with ticagrelor and prasugrel. A single-centre, retrospective audit was conducted to determine the initiation of TAT in patients admitted to the emergency department (ED) with ACS and an existing requirement for OAC therapy.Methods The quality improvement project focussed on patients who were admitted to The Rotherham NHS Foundation Trust, South Yorkshire, with ACS between January 2025 and July 2025. Analysis of electronic health records was undertaken to identify patients with an AF diagnosis who required OAC therapy for prevention of thromboembolic events. Choice of initial therapy was compared with that recommended by ESC guidelines. Management of ACS (percutaneous coronary intervention [PCI] or medical management) and therapy of choice at discharge were also recorded.Results Of the 160 patients presenting to the ED with ACS, 17 met the eligibility criteria for TAT. Among these, 10/17 (59%) were managed medically and 7/17 (41%) underwent PCI. Overall, 12/17 (71%) did not receive initial therapy aligned with ESC guidelines. Of those five patients who did receive correct TAT, one was given rivaroxaban instead of apixaban, and two were switched to incorrect TAT by medical teams following transfer to the acute medical unit.Conclusions These findings demonstrate that patients with ACS who have an existing requirement for OAC therapy are not consistently initiated on the appropriate TAT when presenting to the ED. Given that long-term mortality rates following a myocardial infarction are worse among patients with AF compared with those in sinus rhythm, adherence to a specific treatment pathway is key to improving outcomes in these patients. This is particularly relevant in district general hospitals, where cardiology cover is not always available out of hours and ED staff must rely on local guidelines or familiarity with the correct treatment pathway without specialist input.As a quality improvement measure, targeted education and revision of local ED ACS guidelines will be implemented to support timely initiation of appropriate TAT in this patient group. Repeat data collection will be undertaken following implementation to assess the impact of these interventions on clinical practice and service improvement.",
  "authors": [
    {
      "affiliations": [
        "University of Sheffield Medical School, Sheffield, United Kingdom"
      ],
      "name": "Olivia Fernando"
    },
    {
      "affiliations": [
        "The Rotherham NHS Foundation Trust, Sheffield, United Kingdom"
      ],
      "name": "Simon Williams"
    },
    {
      "affiliations": [
        "The Rotherham NHS Foundation Trust, Sheffield, United Kingdom"
      ],
      "name": "Akshay Gaur"
    },
    {
      "affiliations": [
        "The Rotherham NHS Foundation Trust, Sheffield, United Kingdom"
      ],
      "name": "Philip Rodwell"
    },
    {
      "affiliations": [
        "The Rotherham NHS Foundation Trust, Sheffield, United Kingdom"
      ],
      "name": "Simon Smith"
    }
  ],
  "title": "369 Treatment of acute coronary syndrome (ACS) in patients with an indication for oral anticoagulation (OAC) therapy: a single-centre, retrospective study",
  "uid": "7c4c80f9-33ea-55e4-beef-e7ce0df28375"
}