Abstract
Aim of the present study was to investigate the frequency and predictors of premature discontinuation or switch of ADP receptor blockers and its association with serious adverse events. For this purpose 571 consecutive ACS patients receiving ticagrelor (n = 258, 45%) or prasugrel (n = 313, 55%) undergoing PCI were enrolled in this prospective, observational, multicenter ATLANTIS-SWITCH substudy. Predictors of premature discontinuation or switch of antiplatelet therapy and their association with major adverse cardiovascular events and TIMI bleeding events were evaluated. Premature stop/switch was found in 72 (12.6%) patients: 34 (5.9%) stopped and 38 (6.7%) switched the ADP blocker. Ticagrelor treated patients were significantly more likely to stop/switch therapy as compared to prasugrel (15.9% vs. 9.2%, p = 0.016). We identified 4 independent predictors for stop/switch of ADP blocker: major surgery, need for oral anticoagulation (OAC), TIMI major bleeding and drug intolerance. TIMI major bleeding was a driver of stop/switch actions and occurred in 4.3% vs 0.2% in patients with vs without stop/switch (p = 0.001). The majority of stop/switch actions (75%) were physicians driven decisions. Importantly, stop/switch of therapy was not associated with increased risk of MACE (p = 0.936). In conclusion premature switch/stop of ADP blockers appears to be safe when mainly driven by physician’s decision and clinical indication.
Highlights
Dual antiplatelet therapy (DAPT) of acetylsalicylic acid in combination with an adenosine diphosphate (ADP) inhibitor represents a significant advance in prevention of recurrent ischaemic events following drug eluting stent (DES) implantation[1,2,3]
There is only limited data on long-term adherence to DAPT therapy with novel antiplatelet agents in acute coronary syndrome (ACS) patients. For this purpose we aimed to investigate the incidence and reasons of premature discontinuation or switch of antiplatelet therapy within 12 months after ACS in a multicenter, prospective registry of patients after acute myocardial infarction
Www.nature.com/scientificreports we investigated factors associated with premature discontinuation of ADP blocker or switch between agents and their association with adverse clinical events
Summary
Dual antiplatelet therapy (DAPT) of acetylsalicylic acid in combination with an adenosine diphosphate (ADP) inhibitor represents a significant advance in prevention of recurrent ischaemic events following drug eluting stent (DES) implantation[1,2,3]. In patients with high ischemic risk like after acute coronary syndrome (ACS), current guidelines recommend DAPT for at least 12 month after DES implantation[4]. Premature cessation of antiplatelet therapy has been associated with catastrophic ischemic events like stent thrombosis of recurrent ACS10. There is only limited data on long-term adherence to DAPT therapy with novel antiplatelet agents in ACS patients. For this purpose we aimed to investigate the incidence and reasons of premature discontinuation or switch of antiplatelet therapy within 12 months after ACS in a multicenter, prospective registry of patients after acute myocardial infarction. Www.nature.com/scientificreports we investigated factors associated with premature discontinuation of ADP blocker or switch between agents and their association with adverse clinical events
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