Reasons for early discontinuing or switching of antiplatelet therapy in elderly patients after acute coronary syndrome

Gimbel, Marieke E.; Vos, Gerrit J.A.; Nguyen, Thuc A.; Kelder, Johannes C.; Berg, Jürrien M. ten

doi:10.1097/mca.0000000000000787

Cited by 10 publications

(9 citation statements)

References 14 publications

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“…However, after multivariate adjustment, this difference was not significant anymore. In agreement with our results, previous studies indicate PCI treatment as a predictor of DAPT adherence [6]. In our study, concomitant anticoagulant therapy was not an independent predictor of adherence (upper 95% CI boundary was 1.03), however the effect measure was heavily on the side of reduced adherence, in line with the findings in the ATLANTIS-SWITCH study [4].…”

Section: Fig 3 Kaplan-meier Curves Of Major Adverse Cardiovascular Ev...supporting

confidence: 92%

“…Premature discontinuation of DAPT treatment during the first 12 months after the ACS event is not uncommon and has been so far linked to several factors. Current studies suggest that ticagrelor and prasugrel-treated patients are more prone to premature discontinuation than clopidogrel-treated patients [4][5][6]8,19,20]. In contrast, in the univariate analysis, patients treated with potent P2Y12 inhibitors as a form of DAPT were found to be more adherent than the patients treated with clopidogrel in our study.…”

Section: Fig 3 Kaplan-meier Curves Of Major Adverse Cardiovascular Ev...contrasting

confidence: 78%

“…Discontinuation of P2Y12 inhibitor is often defined in studies as the temporary or definite cessation of an antiplatelet agent within the first year of DAPT. Main reasons for discontinuation include, among others, major bleedings, need for major surgery, need for oral anticoagulant, drug intolerance and older age [4][5][6][7]. Only a few studies have attempted to clarify whether interruption of adherence to the 12-month DAPT is related to the potency of P2Y12 inhibitors.…”

Section: Introductionmentioning

confidence: 99%

“…Only a few studies have attempted to clarify whether interruption of adherence to the 12-month DAPT is related to the potency of P2Y12 inhibitors. Most of them suggest that discontinuation occurs more often in patients receiving ticagrelor or prasugrel than clopidogrel treatment [4][5][6]8]. On the other hand, deescalation of the P2Y12 inhibition is defined as a decrease in platelet inhibition and includes switching from potent P2Y12 inhibitor to clopidogrel [9].…”

Section: Introductionmentioning

confidence: 99%

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

Kourti¹,

Konstantas²,

Farmakis³

et al. 2022

Rev. Cardiovasc. Med.

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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.

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Section: Fig 3 Kaplan-meier Curves Of Major Adverse Cardiovascular Ev...supporting

confidence: 92%

Section: Fig 3 Kaplan-meier Curves Of Major Adverse Cardiovascular Ev...contrasting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Kourti¹,

Konstantas²,

Farmakis³

et al. 2022

Rev. Cardiovasc. Med.

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show abstract

“…However, several previous studies have reported that older patients receiving more potent P2Y12 inhibitors have a higher risk of bleeding ( 24 ) and even life-threatening bleeding (e.g., fatal intracranial bleeding) than younger patients, which leads to earlier mortality and reduced net clinical benefit. Additionally, premature discontinuation due to minor bleeding also places patients at a high risk for ischemic events ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

Ticagrelor vs. Clopidogrel in Older Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: Insights From a Real-World Registry

Zhang

Peng

Shi

et al. 2022

Front. Cardiovasc. Med.

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Background and ObjectivesIt is unclear whether more potent P2Y12 inhibitors are of benefit to older patients who are at high risk for both ischemia and bleeding. We conducted an observational study to compare the clinical outcomes of clopidogrel and ticagrelor uses in older patients with an acute coronary syndrome (ACS).MethodsOlder patients (aged ≥65 years) with ACS who underwent percutaneous coronary intervention (PCI) were divided into clopidogrel-treated and ticagrelor-treated groups. The primary observational endpoint was the occurrence of net adverse clinical and cerebral events (NACCEs) during a 12-month period, which is defined as the composite endpoint of all-cause death, myocardial infarction (MI), stroke, stent thrombosis, urgent coronary revascularization, and clinically significant bleeding. The secondary endpoints were clinically significant bleeding and major adverse clinical and cerebral events (MACCEs).ResultsThis study included a total of 2,611 patients. Of them, 1,636 received clopidogrel and 975 received ticagrelor. Between patients receiving clopidogrel and those receiving ticagrelor, no significant differences were noted in NACCE (8.4 vs. 9.7%, respectively; adjusted hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.66–1.12) or MACCE (7.1 vs. 7.0%, respectively; adjusted HR, 1.13; 95% CI, 0.83–1.55) during the 12-month follow-up period. In contrast, the occurrence of clinically significant bleeding was significantly less in clopidogrel-treated patients compared with that in ticagrelor-treated patients (27, 1.7%, vs. 31, 3.2%, respectively; adjusted HR, 0.42; 95% CI, 0.25–0.69). Stratified analyses revealed no significant association between age (≥75 years vs. <75 years) and treatment condition in terms of primary or secondary endpoints.ConclusionThis study showed that clopidogrel and ticagrelor had comparable net clinical benefits in patients with ACS aged ≥65 years. Additionally, clopidogrel was associated with a significantly lower risk of major bleeding than ticagrelor without an increase in ischemic risk. These findings suggest that clopidogrel is an effective alternative to the more potent P2Y12 inhibitor ticagrelor in older patients.

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The ABCD-GENE Score for Clopidogrel Response

Bittl¹

2020

JACC: Cardiovascular Interventions

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Reasons for early discontinuing or switching of antiplatelet therapy in elderly patients after acute coronary syndrome

Cited by 10 publications

References 14 publications

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

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

Ticagrelor vs. Clopidogrel in Older Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: Insights From a Real-World Registry

The ABCD-GENE Score for Clopidogrel Response

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