One‐year efficacy and safety of prasugrel and ticagrelor in patients with acute coronary syndromes: Results from a prospective and multicentre ACHILLES registry

Abstract

Background: Prasugrel and ticagrelor have demonstrated higher efficacy than clopidogrel in their main clinical trials for patients with acute coronary syndrome (ACS). However, the long-term prognosis and different clinical characteristics related to the type of antiplatelet prescription in current clinical practice ACS patients have not been analysed in depth. The objective of this study was to analyse the clinical profile of ACS and the efficacy and safety of novel oral P2Y 12 inhibitors in current clinical practice patients discharged after ACS. Methods:We collected data from the ACHILLES registry, and an observational, prospective and multicentre registry of patients discharged after ACS. We analysed baseline characteristics, clinical profile and therapy during ACS admission and compared with the different treatments at discharge. After 1 year of follow-up, ischaemic and major bleeding events were analysed. Multivariate Cox regression analysis and Kaplan Meier curves were also plotted.Results: Of 1717 consecutive patients, 1294 (75.4%) were discharged with a P2Y12 inhibitor without oral anticoagulation. Novel oral P2Y 12 inhibitors were indicated in 47%. Patients treated with clopidogrel were elderly (69.1 ± 13.4 vs 60.4 ± 11.5 years; P < .001) and had a higher prevalence of cardiovascular risk factors. GRACE and CRUSADE scores were higher in the clopidogrel than in novel oral P2Y 12 inhibitors group (P < .001). After 1 year of follow-up, 64 (5.0%/year) patients had a new myocardial infarction, 127 (10.0%/year) had a major adverse cardiovascular event (MACE) and 78 (6.1%/year) died. Patients treated with clopidogrel had a The authors confirm that the Principal Investigator for this paper is J.M.R.-N. All patients included in the ACHILLES registry, 1717 patients, provided individual signed informed consent and an external independent audit of the registry data (independent clinical research organization) was performed evaluating the correct inclusion of the patients, data analysed, compliance with the ethical principles and the presence of all signed informed consent of the patients included.

Platelet inhibition by P2Y12 antagonists is potentiated by adenosine signalling activators

“…Platelets, responsible for the prevention of blood loss at sites of vascular injury, are also central to the formation of arterial thrombi and subsequent ischemic events including myocardial infarctions (Ruiz-Nodar et al, 2020). Antiplatelet drug therapy impairs the formation and progression of thrombi and thus constitutes the cornerstone of cardio-protective medications.…”

Associations of antithrombotic agent use with clinical outcomes in critically ill patients with troponin I elevation in the absence of acute coronary syndrome

“…These medications lowered risk of further major adverse cardiovascular events which may reduce all-cause mortality. [6,28] In a previous study, 4.7% of patients admitted to the ICU developed at least one episode of overt gastrointestinal bleeding, and 2.6% experienced clinically important gastrointestinal bleeding which subsequently increased risk of mortality. [29,30] However, prevalence of overt gastrointestinal bleeding was not altered by treatment of aspirin or anticoagulant medication during ICU stay in previous cohort study (Odd ratio: 0.76, 95% CI: 0.35-1.64) and (Odd ratio: 2.05, 95% CI: 0.89-4.73) respectively as coagulopathy, acute kidney injury or co-existing liver disease were independent risk factors for clinically important GI bleeding in these patients apart from adverse effect of anticoagulant.…”

Extended use of dual antiplatelet therapy among older adults with acute coronary syndromes and associated variables: a cohort study

“…Most elderly patients are managed conservatively in routine clinical practice because of the risk of bleeding [ 7 ]. In this context, clopidogrel is generally prescribed in preference to ticagrelor or prasugrel [ 8 ]. There are no data available about the real-world implementation of extended DAPT strategies, and their associated predictors, in older adults with ACS.…”