M B Yudi1,2, D J Clark1,2, O Farouque1,2, D Eccleston3, N Andrianopoulos4, S J Duffy4,5, A Brennan4, J Lefkovits3, J Ramchand1, T Yip6, E Oqueli7, C M Reid4,8, A E Ajani2,3,4. 1. Department of Cardiology, Austin Health, Melbourne, Victoria, Australia. 2. The University of Melbourne, Melbourne, Victoria, Australia. 3. Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia. 4. Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia. 5. Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia. 6. Department of Cardiology, Geelong University Hospital, Geelong, Victoria, Australia. 7. Department of Cardiology, Ballarat Base Hospital, Ballarat, Victoria, Australia. 8. School of Public Health, Curtin University, Perth, Western Australia, Australia.
Abstract
BACKGROUND: Guidelines recommend prasugrel or ticagrelor instead of clopidogrel in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary interventions (PCI). AIM: We sought to describe the trends in uptake of the newer agents and analyse the clinical characteristics and short-term outcomes of patients treated with clopidogrel, prasugrel or ticagrelor. METHODS: We analysed the temporal trends of antiplatelet use since the availability of prasugrel (2009-2013) in patients with ACS from the Melbourne Interventional Group registry. To assess clinical characteristics and outcomes, we included 1850 patients from 2012 to 2013, corresponding to the time all three agents were available. The primary outcome was major adverse cardiovascular events (MACE). The safety end-point was in-hospital bleeding. RESULTS: For the period of 2009-2013, the majority of patients were treated with clopidogrel (72%) compared with prasugrel (14%) or ticagrelor (14%). There was a clear trend towards ticagrelor by the end of 2013. Patients treated with clopidogrel were more likely to present with non-ST-elevation ACS, be older, and have more comorbidities. There was no difference in unadjusted 30-day mortality (0.9 vs 0.5 vs 1.0%, P = 0.76), myocardial infarction (2 vs 1 vs 2%, P = 0.52) or MACE (3 vs 3 vs 4%, P = 0.57) between the three agents. There was no difference in in-hospital bleeding (3 vs 2 vs 2%, P = 0.64). CONCLUSION: Prasugrel and ticagrelor are increasingly used in ACS patients treated with PCI, predominantly in a younger cohort with less comorbidity. Although antiplatelet therapy should still be individualised based on the thrombotic and bleeding risk, our study highlights the safety of the new P2Y12 inhibitors in contemporary Australian practice.
BACKGROUND: Guidelines recommend prasugrel or ticagrelor instead of clopidogrel in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary interventions (PCI). AIM: We sought to describe the trends in uptake of the newer agents and analyse the clinical characteristics and short-term outcomes of patients treated with clopidogrel, prasugrel or ticagrelor. METHODS: We analysed the temporal trends of antiplatelet use since the availability of prasugrel (2009-2013) in patients with ACS from the Melbourne Interventional Group registry. To assess clinical characteristics and outcomes, we included 1850 patients from 2012 to 2013, corresponding to the time all three agents were available. The primary outcome was major adverse cardiovascular events (MACE). The safety end-point was in-hospital bleeding. RESULTS: For the period of 2009-2013, the majority of patients were treated with clopidogrel (72%) compared with prasugrel (14%) or ticagrelor (14%). There was a clear trend towards ticagrelor by the end of 2013. Patients treated with clopidogrel were more likely to present with non-ST-elevation ACS, be older, and have more comorbidities. There was no difference in unadjusted 30-day mortality (0.9 vs 0.5 vs 1.0%, P = 0.76), myocardial infarction (2 vs 1 vs 2%, P = 0.52) or MACE (3 vs 3 vs 4%, P = 0.57) between the three agents. There was no difference in in-hospital bleeding (3 vs 2 vs 2%, P = 0.64). CONCLUSION:Prasugrel and ticagrelor are increasingly used in ACS patients treated with PCI, predominantly in a younger cohort with less comorbidity. Although antiplatelet therapy should still be individualised based on the thrombotic and bleeding risk, our study highlights the safety of the new P2Y12 inhibitors in contemporary Australian practice.
Authors: Marta Rasia; Emilia Solinas; Massimiliano Marino; Paolo Guastaroba; Alberto Menozzi; Maria Alberta Cattabiani; Iacopo Tadonio; Rossana De Palma; Luigi Vignali Journal: J Thromb Thrombolysis Date: 2017-11 Impact factor: 2.300
Authors: Seng Chan You; Yeunsook Rho; Behnood Bikdeli; Jiwoo Kim; Anastasios Siapos; James Weaver; Ajit Londhe; Jaehyeong Cho; Jimyung Park; Martijn Schuemie; Marc A Suchard; David Madigan; George Hripcsak; Aakriti Gupta; Christian G Reich; Patrick B Ryan; Rae Woong Park; Harlan M Krumholz Journal: JAMA Date: 2020-10-27 Impact factor: 56.272
Authors: Maximilian Tscharre; Florian Egger; Matthias Machata; Miklos Rohla; Nadia Michael; Manuel Neumayr; Robert Zweiker; Johannes Hajos; Christopher Adlbrecht; Markus Suppan; Wolfgang Helmreich; Bernd Eber; Kurt Huber; Thomas W Weiss Journal: PLoS One Date: 2017-06-20 Impact factor: 3.240
Authors: Sukhdeep S Basra; Tracy Y Wang; DaJuanicia N Simon; Karen Chiswell; Salim S Virani; Mahboob Alam; Vijay Nambi; Ali E Denktas; Anita Deswal; Biykem Bozkurt; Christie M Ballantyne; Eric D Peterson; Hani Jneid Journal: J Am Heart Assoc Date: 2018-06-09 Impact factor: 5.501
Authors: Shashank Murali; Sara Vogrin; Samer Noaman; Diem T Dinh; Angela L Brennan; Jeffrey Lefkovits; Christopher M Reid; Nicholas Cox; William Chan Journal: J Clin Med Date: 2020-05-11 Impact factor: 4.241
Authors: Oliver Heidmann Pedersen; Mads Lamm Larsen; Steen Dalby Kristensen; Anne-Mette Hvas; Erik Lerkevang Grove Journal: Am J Case Rep Date: 2017-09-01