79 Improving guideline directed dual anti-platelet therapy administration and appropriate timing of second antiplatelet loading in patients presenting with non-ST elevation myocardial infarction (NSTEMI) and unstable angina

Introduction The correct choice of antiplatelet therapy is crucial for patients admitted with NSTEMI and Unstable Angina as per the European Society of Cardiology (ESC) 2023 guidelines. Following loading with aspirin, appropriate selection and timing of second antiplatelet therapy is associated with decreased mortality and enhanced patient outcomes. Prasugrel or ticagrelor are the recommended choice of second antiplatelet in these patients. Clopidogrel is known to be inferior to these agents in terms of inhibition of platelets and it should only be given if prasugrel or ticagrelor are contraindicated or in patients with high bleeding risk. The correct timing of the second antiplatelet agent is also crucial. Pre-treatment with the second antiplatelet agent at the time of diagnosis and before the coronary angiogram is not associated with any improved ischaemic outcome but it is rather associated with increased risk of bleeding. This Quality Improvement Project (QIP) aims to assess the adherence of the New Cross Hospital to these specified guidelines and implementation of interventions to improve adherence. Methods Retrospective data collection of electronic patient records admitted between September 2023 and November 2023 with diagnosed NSTEMI and Unstable Angina for patients aged more than 18 years, planned to undergo PCI, and no contraindications to starting anti-platelet agents. Following collection and analysis of data, interventions were introduced including implementation of regular teaching to junior doctors, active involvement in data collection of the junior doctors and understanding of dual antiplatelet guidelines through posters on the ward. Results The first cycle of the QIP comprised of 17 patients. The analysis of data from this cycle showed that 47%(n=8) patients were loaded with second anti-platelet agent prior to the Invasive Angiogram. It further highlighted that 41%(n=7) patients were loaded with clopidogrel instead of prasugrel or ticagrelor. Significant improvement was noted following the interventions. The succeeding cycle had a total of 18 patients.17%(n=3) of these patients were loaded prior to the invasive angiogram and these patients were loaded with clopidogrel. Hence, following intervention 83% of patients were treated as per ESC guidelines. Conclusion The QIP highlighted initial low compliance with the ESC guidelines for second anti-platelet loading but this improved significantly. Hence, effective communication between the stakeholders, regular teaching sessions and enhanced developments will improve patient outcomes. Conflict of Interest None