Contraindications/Special Warnings and Precautions for Use of Contemporary Oral Antiplatelet Treatment in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Alexopoulos, Dimitrios; Xanthopoulou, Ioanna; Deftereos, Spyridon; Sitafidis, George; Kanakakis, Ioannis; Hamilos, Michalis; Vavuranakis, Manolis; Davlouros, Periklis; Ntalas, Ioannis; Angelidis, Christos; Hahalis, George; Triposkiadis, Filippos; Vardas, Panos; Stefanadis, Christodoulos; Goudevenos, John

doi:10.1253/circj.cj-13-0795

Cited by 16 publications

(10 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As prescription of P2Y 12 receptor antagonists in real life occurs according to established contraindications and special precautions for each of them, significant differences in baseline characteristics that have an impact on both ischemic and bleeding outcomes are expected [10], [14,15]. Although statistical adjustment may account for some of these differences, prescription of prasugrel in a 'lower-risk, real-life' population may contribute to a reduced rate of MACE compared with clopidogrel.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Partial results from GRAPE, along with a detailed protocol, have been previously published [15,16]. Briefly, consecutive, moderate to high-risk ACS patients receiving PCI who had been enrolled between January 2012 and August 2013 were included in this analysis.…”

Section: Study Protocolmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…End-stage renal failure requiring hemodialysis needs special attention for both ticagrelor and clopidogrel. Conditions and comedication related to increased bleeding risk are also common for ticagrelor and clopidogrel, although in 'real life', in their presence, the less potent clopidogrel is preferred [9]. Cotreatment with moderate/strong CYP2C19 inhibitors requires special attention for clopidogrel administration.…”

mentioning

confidence: 99%

Ticagrelor recommended over clopidogrel in STEMI patients

Pappas

Lekakis

Alexopoulos

2016

Expert Review of Cardiovascular Therapy

Self Cite

View full text Add to dashboard Cite

“…Greek Antiplatelet Registry is a prospective, observational, multicenter cohort ongoing study focusing on contemporary antiplatelet use in eight Greek Hospitals with PCI facilities. Details on GRAPE have been previously published . Briefly, consecutive, moderate‐to‐high‐risk ACS patients undergoing PCI, which have been enrolled between January 2012 and August 2013, are presented in this analysis.…”

Section: Methodsmentioning

confidence: 99%

“…Greek Antiplatelet Registry (GRAPE) represents a contemporary (2012–2013) cohort of ACS/NSTEMI or STEMI patients receiving PCI and dual antiplatelet treatment with all the three (clopidogrel, prasugrel and ticagrelor) oral P2Y12 inhibitors available for use . In the context of GRAPE, we analyzed bivalirudin treatment patterns and short‐term (one‐month) outcome.…”

Section: Introductionmentioning

confidence: 99%

Bivalirudin Use and One‐Month Outcome in the Context of Contemporary Antiplatelet Treatment: Insights from the Greek Antiplatelet Registry

Alexopoulos

Xanthopoulou

Deftereos

et al. 2014

Cardiovascular Therapeutics

Self Cite

View full text Add to dashboard Cite

SUMMARY Aims:Little is known about the use of bivalirudin in "real life". In the context of contemporary antiplatelet treatment, we aimed to assess bivalirudin treatment patterns and short-term (one-month) outcome. Methods: Greek Antiplatelet Registry (GRAPE) is a prospective, observational, multicenter cohort study of consecutive, moderate-to-high-risk acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI). We assessed bivalirudin treatment patterns and predictive factors for its use. Combined in-hospital and one-month major adverse cardiovascular events (MACE, including death, myocardial infarction, urgent revascularization, and stroke), and bleeding events according to Bleeding Academic Research Consortium (BARC) criteria were analyzed after propensity matching. Results: Of 2047 registered patients, 480 (23.4%) were treated with bivalirudin. Multivariate analysis (C statistic 0.77, 0.75-0.80 95% CIs, P < 0.001) revealed as factors favoring bivalirudin use primary PCI, radial arterial access, presentation with positive biomarkers and use of novel P2Y12 inhibitor, whereas IIb/IIIa inhibitor administration did not. Regional trends also affected bivalirudin's choice. In 370 propensity-matched pairs of patients who received or not bivalirudin, MACE, BARC type 1, 2 and 3 did not differ between groups: 4.1%, 21.9%, 3.2%, 3.5% and 5.1%, 18.9%, 2.7%, 4.3%, respectively, P = nonsignificant for all. Conclusions: In a "real life", contemporary antiplatelet treatment registry, clinical, laboratory and logistic factors affect bivalirudin's choice, while there are no differences in one-month outcome between bivalirudin-treated and non-bivalirudin-treated patients.

show abstract

Contraindications/Special Warnings and Precautions for Use of Contemporary Oral Antiplatelet Treatment in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Cited by 16 publications

References 17 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

Ticagrelor recommended over clopidogrel in STEMI patients

Bivalirudin Use and One‐Month Outcome in the Context of Contemporary Antiplatelet Treatment: Insights from the Greek Antiplatelet Registry

Contact Info

Product

Resources

About