Implementation of contemporary oral antiplatelet treatment guidelines in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A report from the GReek AntiPlatelet rEgistry (GRAPE)

Alexopoulos, Dimitrios; Goudevenos, John; Xanthopoulou, Ioanna; Deftereos, Spyridon; Sitafidis, George; Kanakakis, Ioannis; Hamilos, Michalis; Parissis, Haralabos; Ntalas, Ioannis; Angelidis, Christos; Petousis, Stylianos; Vavuranakis, Manolis; Hahalis, George; Stefanadis, Christodoulos

doi:10.1016/j.ijcard.2013.08.007

Cited by 27 publications

(24 citation statements)

References 16 publications

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“…In line with this, other contemporary registries have also shown a high rate of clopidogrel use in 'real life' [9][10][11]14,18]. Factors affecting the implementation of guidelines have specifically previously analyzed for GRAPE [25].…”

Section: Discussionmentioning

confidence: 87%

Contemporary antiplatelet treatment in acute coronary syndrome patients undergoing percutaneous coronary intervention: 1‐year outcomes from the GReek AntiPlatElet (GRAPE) Registry

Alexopoulos

Xanthopoulou

Deftereos

et al. 2016

Journal of Thrombosis and Haemostasis

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The comparative efficacy and safety of antiplatelet agents in ‘real life’ is not clear. We recruited acute coronary syndrome patients receiving percutaneous coronary intervention. At 1‐year follow‐up, prasugrel offers better anti‐ischemic protection than clopidogrel. Prasugrel and ticagrelor are accompanied by more frequent bleeding events. Summary BackgroundThe comparative efficacy and safety of antiplatelet treatment outside randomized trials is not clear. ObjectivesTo investigate long‐term efficacy and safety in ‘real‐life’ acute coronary syndrome (ACS) patients treated by percutaneous coronary intervention (PCI) with contemporary use of clopidogrel, prasugrel and ticagrelor. MethodsIn a prospective, observational, multicenter cohort study, 2047 patients were recruited into the GReek AntiPlatElet (GRAPE) Registry and were followed‐up for 1 year for major adverse cardiovascular events (MACE, a composite of death, non‐fatal myocardial infarction, urgent revascularization and stroke) and bleeding events (Bleeding Academic Research Consortium [BARC] classification). ResultsExposure to clopidogrel, prasugrel and ticagrelor by PCI occurred in 959, 363 and 717 patients, respectively. After adjustment, the rate of MACE (primary outcome endpoint) was lower in prasugrel‐treated patients (4.4%) than in clopidogrel‐treated patients (10.1%) (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.30–0.91), although not significantly different between ticagrelor (6.8%) and clopidogrel groups (HR, 0.78; 95% CI, 0.54–1.12). Any type of BARC‐classified bleeding (secondary outcome endpoint) was more frequent in prasugrel‐treated patients (51.2%) than in clopidogrel‐treated patients (37.6%) (HR, 1.61; 95% CI, 1.33–1.95) and more frequent in ticagrelor‐treated patients (56.9%) than in clopidogrel‐treated patients (HR, 1.81; 95% CI, 1.55–2.10). An adjusted comparison between prasugrel and ticagrelor‐treated groups did not reveal differences in any outcome measure. After adjustment, the death rate was more reduced by novel agents in comparison with clopidogrel (2.9% vs. 6.2%). ConclusionsIn ACS/PCI patients, prasugrel offered better anti‐ischemic protection than clopidogrel, whereas use of both novel agents is accompanied by more frequent bleeding events.

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Section: Discussionmentioning

confidence: 87%

Contemporary antiplatelet treatment in acute coronary syndrome patients undergoing percutaneous coronary intervention: 1‐year outcomes from the GReek AntiPlatElet (GRAPE) Registry

Alexopoulos

Xanthopoulou

Deftereos

et al. 2016

Journal of Thrombosis and Haemostasis

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“…In addition, these studies did not assess adherence to treatment or 1-year mortality, factors which are provided in the current analysis. Two additional registries have reviewed the use of ticagrelor, but these reports are limited to the evaluation of either the appropriateness of use [13] or the contemporary use of P 2 Y 12 inhibitors [15], without evaluating in-hospital and postdischarge patient outcomes, as well as adherence to therapy. Again, as in the current analysis, it was demonstrated that clopidogrel is the most commonly used P 2 Y 12 inhibitor.…”

Section: Discussionmentioning

confidence: 99%

“…A limited number of studies [9,10,11,12,13,14,15] evaluating the use of novel P 2 Y 12 inhibitors in various settings have suggested a delayed uptake; however, these studies included mostly patients treated with prasugrel, and thus they effected a somewhat ‘biased' approach by excluding patients aged >75 years or those with a prior stroke or a body weight <60 kg. Furthermore, those studies addressed only the issue of in-hospital and short-term follow-up.…”

Section: Introductionmentioning

confidence: 99%

Real-World Use of Novel P2Y12 Inhibitors in Patients with Acute Myocardial Infarction: A Treatment Paradox

et al. 2016

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Objective: To assess the real-world use, clinical outcomes, and adherence to novel P₂Y₁₂ inhibitors. Methods: We evaluated 1,093 consecutive acute myocardial infarction patients undergoing a percutaneous intervention. Patients were derived from a prospective, multicenter, nationwide registry and were followed for 30 days; 381 patients (35%) received clopidogrel, 468 (43%) received prasugrel, and 244 (22%) received ticagrelor. Patients treated with clopidogrel were older and more likely to suffer from chronic renal failure and stroke and/or present with non-ST-elevation myocardial infarction (NSTEMI) (p < 0.01 for all). Independent predictors of undertreatment with novel P₂Y₁₂ inhibitors included: older age (OR 0.17; 95% CI 0.1-0.27, p < 0.0001), a prior stroke (OR 0.41; 95% CI 0.2-0.68, p = 0.008), and NSTEMI (OR 0.37; 95% CI 0.26-0.54, p < 0.0001). Results: Novel P₂Y₁₂ inhibitors were associated with a lower incidence of cardiovascular events, major bleeding, and/or death (7.6 vs.11%, HR 0.67; 95% CI 0.43-1, p = 0.05). However, after a multivariate analysis this trend was not statistically significant. Patients discharged with ticagrelor versus thienopyridines demonstrated a higher rate of crossover to other P₂Y₁₂ inhibitors (11 vs. 5%, p = 0.03). Conclusions: In a real-world cohort, there was an underutilization of novel P₂Y₁₂ inhibitors which was more pronounced in higher-risk subsets that might benefit from novel P₂Y₁₂ inhibitors at least as much as other patients.

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“…It is orally active and does not need metabolic activation. Ticagrelor is reported to have greater benefit in terms of preventing MIs and strokes when compared with clopidogrel with no additional risk of severe or fatal bleeding [65,66]. Ticagrelor provides greater and more consistent inhibition of platelet aggregation than clopidogrel with more rapid onset and offset of action [67].…”

Section: P2y 12 Receptor Inhibitorsmentioning

confidence: 99%

Contemporary antiplatelet therapy in patients undergoing percutaneous coronary intervention

Bhatty

Ali

Shetty

et al. 2014

Expert Review of Cardiovascular Therapy

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The proper use of antiplatelet agents in the cardiac catheterization laboratory is important for ensuring optimal results in patients undergoing percutaneous revascularization. Understanding the mechanisms by which these drugs exerts their effects is important for both interventional and non-interventional cardiologists. The effects of these agents on platelet function can be assessed and monitored using a variety of commercially available laboratory assays but so far these tests have not been adopted in routine clinical practice. Currently, aspirin, thienopyridines and glycoprotein IIb/IIIa inhibitors are the primary types of antiplatelet drugs being utilized. The use of these drugs and of several newer antiplatelet drugs in the treatment of patients undergoing percutaneous revascularization in the cardiac catheterization laboratory will be discussed, especially in the light of the recently published guidelines.

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Implementation of contemporary oral antiplatelet treatment guidelines in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A report from the GReek AntiPlatelet rEgistry (GRAPE)

Cited by 27 publications

References 16 publications

Contemporary antiplatelet treatment in acute coronary syndrome patients undergoing percutaneous coronary intervention: 1‐year outcomes from the GReek AntiPlatElet (GRAPE) Registry

Contemporary antiplatelet treatment in acute coronary syndrome patients undergoing percutaneous coronary intervention: 1‐year outcomes from the GReek AntiPlatElet (GRAPE) Registry

Real-World Use of Novel P2Y12 Inhibitors in Patients with Acute Myocardial Infarction: A Treatment Paradox

Contemporary antiplatelet therapy in patients undergoing percutaneous coronary intervention

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