Key result
Ticagrelor-treated patients were significantly more likely to prematurely stop or switch therapy compared to prasugrel-treated patients (15.9% vs. 9.2%), which was not associated with increased MACE.
Why the study?
The study aimed to investigate the frequency and predictors of premature discontinuation or switch of ADP receptor blockers and its association with serious adverse events.
Does premature discontinuation or switch of prasugrel or ticagrelor increase the risk of MACE or bleeding in ACS patients undergoing PCI?
Observational (n=571)
Yes
Does premature discontinuation or switch of prasugrel or ticagrelor increase the risk of MACE or bleeding in ACS patients undergoing PCI?
Premature switch or stop of potent ADP blockers (ticagrelor or prasugrel) appears safe when driven by physician decision and clinical indication, without increasing the risk of MACE.
Answers are grounded in this paper and cite their sources.
Higher ticagrelor discontinuation rates merit monitoring in DAPT decisions; leaves open whether adherence differences affect MACE in broader ACS populations.
Aim of the present study was to investigate the frequency and predictors of premature discontinuation or switch of ADP receptor blockers and its association with serious adverse events. For this purpose 571 consecutive ACS patients receiving ticagrelor (n = 258, 45%) or prasugrel (n = 313, 55%) undergoing PCI were enrolled in this prospective, observational, multicenter ATLANTIS-SWITCH substudy. Predictors of premature discontinuation or switch of antiplatelet therapy and their association with major adverse cardiovascular events and TIMI bleeding events were evaluated. Premature stop/switch was found in 72 (12.6%) patients: 34 (5.9%) stopped and 38 (6.7%) switched the ADP blocker. Ticagrelor treated patients were significantly more likely to stop/switch therapy as compared to prasugrel (15.9% vs. 9.2%, p = 0.016). We identified 4 independent predictors for stop/switch of ADP blocker: major surgery, need for oral anticoagulation (OAC), TIMI major bleeding and drug intolerance. TIMI major bleeding was a driver of stop/switch actions and occurred in 4.3% vs 0.2% in patients with vs without stop/switch (p = 0.001). The majority of stop/switch actions (75%) were physicians driven decisions. Importantly, stop/switch of therapy was not associated with increased risk of MACE (p = 0.936). In conclusion premature switch/stop of ADP blockers appears to be safe when mainly driven by physician's decision and clinical indication.
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Winter et al. (2019) conducted an observational in Acute coronary syndrome (n=571). Ticagrelor vs. Prasugrel was evaluated on Premature discontinuation or switch of ADP receptor blocker (p=0.016). Ticagrelor-treated patients were significantly more likely to prematurely stop or switch therapy compared to prasugrel-treated patients (15.9% vs. 9.2%), which was not associated with increased MACE.
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