Adherence to dual antiplatelet therapy with ticagrelor in patients with acute coronary syndromes treated with percutaneous coronary intervention in real life. Results of the REAL-TICA registry

Aims: Little is known about the adherence to dual antiplatelet therapy with ticagrelor and reasons for discontinuation in real life. Therefore, we evaluated the 12-month course of patients with acute coronary syndromes (ACS) treated with percutaneous coronary intervention (PCI) and ticagrelor during the acute phase. Methods and results: A total of 614 patients included into the prospective ALKK-PCI Registry between 2014 and 2015 surviving for at least 12 months after discharge provided informations about duration of ticagrelor therapy. In total, 133 patients (21.7%) discontinued ticagrelor prematurely: nine patients before discharge and 124 (20.2%) at a mean 131 days after PCI. Independent baseline predictors for early discontinuation were age >75 years, atrial fibrillation, and prior stroke. Side effects such as dypnoea or bradycardias and bleeding leading to a premature discontinuation of ticagrelor were reported in less than 3% and less than 2% of the total patient population, respectively. In 50% of patients, there was no replacement with another platelet inhibitor after early discontinuation of ticagrelor, while in 28.2% it was replaced by clopidogrel. Bleeding events were observed more often (10.4% vs. 2.7%, P < 0.001) and coronary artery bypass grafting (CABG) (5.3% vs. 0, 4%, P < 0.001) was performed more often in patients with early discontinuation. Conclusion: In this real-life experience of ticagrelor in patients with ACS 22% of patients discontinued ticagrelor early. Side effects were the cause for discontinuation in only 3%, while age >75 years, prior stroke, atrial fibrillation, CABG, and bleeding during follow-up were associated with premature discontinuation.