Switching of Oral P2Y12 Inhibitor Treatment in Patients with Acute Coronary Syndrome: Prevalence, Predictors, and Prognosis

Carrillo-Aleman, L; Marı́n, Francisco; Rivera‐Caravaca, José Miguel; Vicente‐Ibarra, Nuria; Candela-Sanchez, E; Esteve-Pastor, María Asunción; Lozano, Teresa; Sandín‐Rollán, Miriam; Pernias-Escrig, V; Macías, M.; Quintana-Giner, Miriam; Veliz, Andrea; Orenes‐Piñero, Esteban; Martínez, Juan G.; Ruiz-Nodar, Juan M.

doi:10.1007/s40261-018-0736-z

Cited by 2 publications

(2 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Switching was frequent, since roughly 1 out of 5 switched during the first year of followup and approximately reached 30% at the end of followup. Our results, in accordance with existing literature, show that switching from potent P2Y12 inhibitors to clopidogrel within the first year of follow-up is more common than viceversa [8,10]. Other specific predictors for switching were not found.…”

Section: Fig 3 Kaplan-meier Curves Of Major Adverse Cardiovascular Ev...supporting

confidence: 91%

“…On the other hand, deescalation of the P2Y12 inhibition is defined as a decrease in platelet inhibition and includes switching from potent P2Y12 inhibitor to clopidogrel [9]. Although the literature regarding the appropriateness and safety of this practice is limited, studies reveal that switching to clopidogrel occurs mainly due to adverse effects, bleeding episodes, need for concomitant anticoagulation therapy and physician's discretion without any specific reason [4,10].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Potent P2Y12 inhibitors versus clopidogrel to predict adherence to antiplatelet therapy after an acute coronary syndrome: insights from IDEAL-LDL

Kourti¹,

Konstantas²,

Farmakis³

et al. 2022

Rev. Cardiovasc. Med.

View full text Add to dashboard Cite

Background: Superiority of potent P2Y12 inhibitors over clopidogrel after an acute coronary syndrome (ACS) has been well established, however potent P2Y12 inhibition is responsible for more adverse events, which may influence patient adherence to treatment. Aim of the present study is to investigate the adherence to the prescribed P2Y12 inhibitor (P2Y12i) in patients on dual antiplatelet therapy (DAPT) after an ACS. Methods: In an IDEAL-LDL trial substudy, we included 344 patients after ACS discharged on DAPT. The primary outcome was the difference between potent P2Y12i and clopidogrel in terms of adherence, as well as other predictors of adherence to the antiplatelet regimen. Secondary outcomes included the prevalence of DAPT continuation and its predictors and the antiplatelet regimen selection after DAPT. Results: Adherence to the potent P2Y12i and to clopidogrel was observed in 140/178 (78.7%) and 111/166 (66.9%) patients (p = 0.016), respectively. In the multivariate model, after adjustment for P2Y12i switching during the first year of therapy, there was no difference observed in adherence between potent P2Y12i and clopidogrel (odds ratio [OR] = 0.98, 95% confidence interval [CI] = 0.55-1.74). Significant predictors included history of cardiovascular disease (CVD) (OR = 0.51, 95% CI = 0.31-0.86) and percutaneous coronary intervention (PCI) index event treatment (OR = 2.58, 95% CI = 1.38-4.82). Of patients, 72% continued DAPT >12 months and female gender was a negative predictor of DAPT prolongation (adjusted OR = 0.43, 95% CI = 0.21-0.90). DAPT was continued until the end of follow-up in 42.7%, while 54.6% resumed with single antiplatelet regimen. Conclusions: Adherence to DAPT was not affected by the P2Y12i potency, whereas history of CVD and PCI treatment were associated with reduced and increased adherence, respectively. Clinical Trial Registration: NCT02927808, https://clinicaltrials.gov/ct2/show/NCT02927808.

show abstract

Section: Fig 3 Kaplan-meier Curves Of Major Adverse Cardiovascular Ev...supporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Potent P2Y12 inhibitors versus clopidogrel to predict adherence to antiplatelet therapy after an acute coronary syndrome: insights from IDEAL-LDL

Kourti¹,

Konstantas²,

Farmakis³

et al. 2022

Rev. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

Risk Stratification after an Acute Coronary Syndrome: Significance of Antithrombotic Therapy

Бражник

Игоревна

et al. 2021

JCM

View full text Add to dashboard Cite

The impact of the de-escalation strategy of antiplatelet therapy (APT) on the life expectancy after acute coronary syndromes (ACS) and percutaneous coronary intervention (PCI) requires an assessment in real clinical practice. Into the Russian multicentral observational trial (ORACLE II ClinicalTrials.gov number, NCT04068909), 1803 patients with ACS and PCI indications were enrolled. During 12 months of follow-up, 228 all-cause deaths have occurred. The analysis of death predictors was carried out by the classification tree method. Age, an option of antithrombotic therapy, a history of chronic heart failure, and uric acid level had the greatest prognostic value. The death prediction model’s sensitivity was 82.1% in the training cohort and 79.2% in the test cohort. During the observation period, ticagrelor was replaced with clopidogrel (APT de-escalation) in 357 patients. The groups of patients with different antiplatelet therapy options were adjusted for clinical parameters by the pseudorandomization method. The de-escalation group had the lowerest all-cause death rate. The incidence of bleeding and recurrent nonfatal coronary events in the study groups did not differ significantly. Thus, the APT regimen’s advantage of changing from the maximum in the first weeks after ACS to moderate at follow-up has been confirmed. There is an obvious need to study the possibilities of individualizing antiplatelet therapy in patients after acute coronary syndromes.

show abstract

Switching of Oral P2Y12 Inhibitor Treatment in Patients with Acute Coronary Syndrome: Prevalence, Predictors, and Prognosis

Cited by 2 publications

References 24 publications

Potent P2Y12 inhibitors versus clopidogrel to predict adherence to antiplatelet therapy after an acute coronary syndrome: insights from IDEAL-LDL

Potent P2Y12 inhibitors versus clopidogrel to predict adherence to antiplatelet therapy after an acute coronary syndrome: insights from IDEAL-LDL

Risk Stratification after an Acute Coronary Syndrome: Significance of Antithrombotic Therapy

Contact Info

Product

Resources

About