Prevalence, Predictors, and Long-Term Prognosis of Premature Discontinuation of Oral Antiplatelet Therapy After Drug Eluting Stent Implantation

Rossini, Roberta; Capodanno, Davide; Lettieri, Corrado; Musumeci, Giuseppe; Nijaradze, Tamar; Romano, Michele; Lortkipanidze, Nikoloz; Cicorella, Nicola; Biondi‐Zoccai, Giuseppe; Sirbu, Vasile; Izzo, Antonio; Guagliumi, Giulio; Valsecchi, Orazio; Gavazzi, Antonello; Angiolillo, Dominick J.

doi:10.1016/j.amjcard.2010.08.067

Cited by 119 publications

(105 citation statements)

References 33 publications

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“…A discontinuation of antiplatelet drugs early after CHD and PCI might lead to a recurrent ACS event 8. In the present study, the nonpersistent user proportion at 1 year was driven mostly by early discontinuation within 6 months.…”

Section: Discussionmentioning

confidence: 45%

Patterns of antiplatelet drug use after a first myocardial infarction during a 10‐year period

Yasmina

Boer

Deneer

et al. 2016

Brit J Clinical Pharma

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AimsThe aims of the present study were to assess antiplatelet drug use patterns after a first myocardial infarction (MI) and to evaluate the determinants of antiplatelet nonpersistence.MethodsThe present study was conducted in 4690 patients from the Utrecht Cardiovascular Pharmacogenetics cohort with a first MI between 1986 and 2010, who were followed for a maximum of 10 years. Medication use and event diagnosis were obtained from the Dutch PHARMO Record Linkage System. Antiplatelet drug users were classified as persistent users (gap between prescriptions ≤90 days), nonpersistent users (>90‐day gap and no refills), and restarters (a new prescription after a >90‐day gap). The association between potential determinants and antiplatelet nonpersistence was analysed using Cox regression.ResultsThe proportions of persistent users decreased from 84.0% at the 1‐year follow‐up to 32.8% at 10 years for any antiplatelet drug, and 77.3% to 27.5% for aspirin; and 39.0% to 6.4% for clopidogrel at 6 years. Most nonpersistent users restarted antiplatelet drugs later, leading to 89.3% overall antiplatelet drug users at 10 years after MI. Diabetes (hazard ratio [HR] 0.44; 0.32–0.60), hypertension (HR 0.77; 0.60–0.99), hypercholesterolaemia (HR 0.49; 0.39–0.62) and more recent MI diagnosis period (2003–2007: HR 0.69, 0.61–0.79; 2008–2010: HR 0.38, 0.19–0.77, compared to ≤ 2002 period) lowered the risk of antiplatelet nonpersistence, while vitamin K antagonist (VKA) comedication (HR 18.97; 16.91–21.28) increased this risk.ConclusionsA large proportion of patients with a first MI still used antiplatelet drugs after 10 years. The frequent discontinuations during this time frame are expected to reduce the effectiveness of antiplatelet drugs as secondary prevention of cardiovascular diseases. Diabetes, hypertension, hypercholesterolaemia, VKA comedication and MI diagnosis period were determinants of antiplatelet nonpersistence.

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Section: Discussionmentioning

confidence: 45%

Patterns of antiplatelet drug use after a first myocardial infarction during a 10‐year period

Yasmina

Boer

Deneer

et al. 2016

Brit J Clinical Pharma

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“…Elle est recommandée durant l'année qui suit un SCA, en particulier un infarctus du myocarde (IDM) [13]. La durée optimale d'une bithérapie est controversée car des études rapportent la survenue d'accidents thrombotiques suite à l'arrêt prématurée de la thiénopyridine associée [251,252]. La durée minimale de prescription d'une bithérapie est de 1 à 3 mois après une angioplastie carotidienne ou intracrânienne, de 1 mois après la pose d'un stent nu [270] et de 6 à 12 mois après la pose d'un stent actif [8,121].…”

Section: Les Enjeuxunclassified

Gestion péri-opératoire des patients traités par antithrombotiques en chirurgie orale. Argumentaire

2015

Med Buccale Chir Buccale

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“…In a retrospective analysis, the incidence of ischaemic complications after the implantation of drug eluding stents (DES) was higher in the group of patients who stopped APA prematurely, with 28.6% of major adverse cardiac events and 7.6% of stent thrombosis [52]; mortality (13.4%) and cardiovascular death (5%) were also significantly greater among patients who discontinued early. The earlier the cessation, the higher the risk of major adverse cardiac events, stent thrombosis, and death (with greatest risk within the first 30 days) [53,54].…”

Section: Risk Factors For Ischaemic Eventsmentioning

confidence: 99%

“…However, when the thrombotic risk is deemed high, ticagrelor should be preferred over clopidogrel, although it might increase the bleeding risk. The thrombotic risk is highest during the first 4 to 6 weeks after a DES implant, and antiplatelet inefficacy or withdrawal during this period can lead to major adverse cardiac events (stent thrombosis, myocardial infarction or death) [52,53,86]. In patients with both high thrombotic and high haemorrhagic risks, for whom DES may be a clear indication, we propose that the association of aspirin plus ticagrelor should be used for 1 to 2 months after a DES implant (when the thrombotic risk is highest).…”

Section: When To Prefer Older Over Newer Apamentioning

confidence: 99%

How to manage prasugrel and ticagrelor in daily practice

Bonhomme¹,

Fontana²,

Reny³

2014

European Journal of Internal Medicine

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Prasugrel and ticagrelor are next-generation antiplatelet agents that provide a rapider and more potent inhibition of platelet P2Y12 receptor than clopidogrel. In combination with aspirin, these new P2Y12 inhibitors are now the first line treatments for patients with acute coronary syndrome. However, these potent antiplatelet agents introduce a new paradigm in the daily management of antithrombotic drugs, particularly when an invasive procedure is planned. The pharmacology of these antiplatelet agents, and the results of the main clinical trials, are reviewed with a special focus on good prescription practices (indications, contra-indications, drug interactions), and on peri-operative management. Strategies are proposed for safely reducing the bleeding risk in elderly patients, in patients requiring concomitant oral anticoagulant therapy, or in patients with an increased haemorrhagic risk.

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Prevalence, Predictors, and Long-Term Prognosis of Premature Discontinuation of Oral Antiplatelet Therapy After Drug Eluting Stent Implantation

Cited by 119 publications

References 33 publications

Patterns of antiplatelet drug use after a first myocardial infarction during a 10‐year period

Patterns of antiplatelet drug use after a first myocardial infarction during a 10‐year period

Gestion péri-opératoire des patients traités par antithrombotiques en chirurgie orale. Argumentaire

How to manage prasugrel and ticagrelor in daily practice

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