Background
Dual antiplatelet therapy is the current standard of care after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). We intended to study the pattern of use of ticagrelor in patients with acute coronary syndrome undergoing PCI and the effect of switching over to other P2Y12 receptor inhibition on clinical outcomes.
Results
All patients aged > 18 years who had been admitted with acute coronary syndrome and had been provided ticagrelor as the second antiplatelet agent were included as study participants. The primary outcome of the study was the composite outcome of death, recurrent myocardial infarctions, re-intervention, and major bleeding.
We studied 321 patients (54 female patients, 16.82%). The mean age of the patients was 56.65 ± 11.01 years. Ticagrelor was stopped in 76.7% on follow-up. It was stopped in 6.3%, 13.5%, 13.1%, 21.9%, and 45.1% of patients during the first month but after discharge, between first and third months, between 3 and 6 months, between 6 and 12 months, and after 12 months, respectively. In the majority of patients, ticagrelor was replaced by clopidogrel (97.9%). It was stopped according to the physician’s discretion in 79.3% of patients, whereas it was the cost of the drug that made the patient to get swapped to another agent in 18.6%. No difference in the primary composite outcome was observed between the groups where ticagrelor was continued post 12 months and ticagrelor was continued and ticagrelor was switched-over to another agent. Similarly, no difference in death, recurrent myocardial infarctions, re-interventions, or major bleeding manifestations was observed between the two groups.
Conclusion
In patients with acute coronary syndrome who undergo PCI, we observed that early discontinuation of ticagrelor and switching over to other P2Y12 inhibitors after discharge did not affect clinical outcomes.
Acute Pulmonary Thromboembolism [PE] is associated with high mortality, similar to that of myocardial infarction and stroke. We studied the clinical presentation and management of PE in the Indian population. An analysis of 140 patients who presented with acute PE at a large volume center in India from June 2015 through December 2018 was performed. The mean age of our study population was 50 years with 59% being male. Comorbidities including Deep Vein Thrombosis [DVT], diabetes mellitus, hypertension, and Chronic Obstructive Pulmonary Disease [COPD] were present in 52.9%, 40%, 35.7% and 7.14% of patients, respectively. Out of 140 patients, 40 [28.6%] patients had massive PE, 36 [25.7%] sub-massive PE, and 64 [45.7%] had low risk PE. Overall, in-hospital mortality was 25.7%. Multivariate regression analysis found chronic kidney disease and PE severity to be the only independent risk factors. Thrombolysis was performed in 62.5% of patients with a massive PE and 63.9% of patients with a sub-massive PE. In the massive PE group, patients receiving thrombolytic therapy had lower mortality compared with patients who did not receive therapy[p=0.022], whereas this difference was not observed in patients in the sub-massive PE group. We conclude that patients with acute PE in India presented more than a decade earlier than our western counterparts, and it was associated with poor clinical outcomes. Thrombolysis was associated with significantly reduced in-hospital mortality in patients with massive PE.
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