What question did this study set out to answer?

To evaluate the contemporary frequency, safety, and effectiveness of in-hospital switching between clopidogrel and higher-potency ADP receptor inhibitors in patients treated with percutaneous coronary intervention for acute myocardial infarction.

December 16, 2014European Heart Journal Acute Cardiovascular Care

In-hospital switching between adenosine diphosphate receptor inhibitors in patients with acute myocardial infarction treated with percutaneous coronary intervention: Insights into contemporary practice from the TRANSLATE-ACS study

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Why the study?

Does in-hospital switching between ADP receptor inhibitors affect MACE or bleeding in myocardial infarction patients treated with percutaneous coronary intervention?

Key Points

To evaluate the contemporary frequency, safety, and effectiveness of in-hospital switching between clopidogrel and higher-potency ADP receptor inhibitors in patients treated with percutaneous coronary intervention for acute myocardial infarction.
Analyzed 11,999 patients with acute myocardial infarction treated with percutaneous coronary intervention across 230 hospitals between April 2010 and October 2012 in the observational TRANSLATE-ACS study.
Used multivariable Cox regression to assess 6-month post-discharge risks of major adverse cardiovascular events (MACE) and GUSTO-defined bleeding comparing in-hospital drug switching with continuation of the initial therapy.
Switching from clopidogrel to prasugrel or ticagrelor occurred in 11.4% (994/8,715) of patients and was not associated with increased bleeding compared to continuing clopidogrel (2.7% vs. 3.3%; adjusted HR 0.96, 95% CI 0.64–1.42, p=0.82).
Switching from prasugrel or ticagrelor to clopidogrel occurred in 13.6% (448/3,284) of patients and was not associated with an increased risk of MACE compared to remaining on higher-potency therapy (8.9% vs. 7.7%; adjusted HR 1.06, 95% CI 0.75–1.49, p=0.76).

Structured PICO

Does in-hospital switching between ADP receptor inhibitors affect MACE or bleeding in myocardial infarction patients treated with percutaneous coronary intervention?

Population

11,999 myocardial infarction patients treated with percutaneous coronary intervention at 230 hospitals

Intervention

In-hospital switching between adenosine diphosphate (ADP) receptor inhibitors (clopidogrel to prasugrel or ticagrelor, or prasugrel or ticagrelor to clopidogrel)

Comparator

Continuation of the initially selected ADP receptor inhibitor therapy

Outcome

Six-month post-discharge risks of major adverse cardiovascular events (MACE: death, myocardial infarction, stroke, or unplanned revascularization) and Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO)-defined bleedingcomposite

In-hospital switching of ADP receptor inhibitors in MI patients post-PCI is common and does not appear to significantly increase the risk of MACE or bleeding.

Discussion

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Implication

Switching ADP inhibitors post-MI PCI was not associated with excess MACE or bleeding; should not yet change practice pending randomized confirmation.

Cite This Study

Bagai et al. (2014) studied this question.

synapsesocial.com/papers/6a71992cac440176ef2a3c68 https://doi.org/10.1177/2048872614564082

Topics

Dual antiplatelet therapy Percutaneous coronary intervention

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Implication

Switching ADP inhibitors post-MI PCI was not associated with excess MACE or bleeding; should not yet change practice pending randomized confirmation.

In-hospital switching between adenosine diphosphate receptor inhibitors in patients with acute myocardial infarction treated with percutaneous coronary intervention: Insights into contemporary practice from the TRANSLATE-ACS study

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

In-hospital switching between adenosine diphosphate receptor inhibitors in patients with acute myocardial infarction treated with percutaneous coronary intervention: Insights into contemporary practice from the TRANSLATE-ACS study

Key Points

Structured PICO

Discussion

Implication

Cite This Study

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