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

Abstract

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.

The Impact of Patient Adherence to Dual Antiplatelet Medication Following Percutaneous Coronary Intervention on the Occurrence of Adverse Cardiovascular Events

“…Importantly, those displaying nonadherence were four times more likely to undergo recurrent acute coronary events (11.0% vs 2.8%, p=0.044). 12 In a parallel study by O. Kourti, 13 adherence to antiplatelet therapy was assessed, yielding no discernible association with the chosen P2Y12 inhibitor. In our study, clopidogrel was the secondary component of DAPT for all patients.…”

The Efficacy and Safety of Proton Pump Inhibitors Combining Dual Antiplatelet Therapy in Patients with Coronary Intervention: A Systematic Review, Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials

“…They found a non-significant variation in MACEs incidence rate, while the incidence rate of gastrointestinal bleeding significantly declined [ 25 ]. For patients with high bleeding risk, de-escalation from ticagrelor to clopidogrel is common [ 37 ]. There is still an absence of adequate proof regarding the combination of PPI with aspirin and ticagrelor, and more studies are needed in the future [ 38 ].…”

Dual Antiplatelet Therapy

“…Novel and trending studies have compared the efficacy of other potent P2Y12 antagonist such as ticagrelor and prasugrel with clopidogrel especially in preventing nonfatal MI, ischemic CVS events, stroke, and other CVS-related death [38]. DAPT with aspirin and clopidogrel is also approved for treating patients with severe stenosis of the intracranial artery [39] and chronic symptomatic peripheral artery diseases (PADs) [40].…”