Key result
Early discontinuation of ticagrelor and switching to other P2Y12 inhibitors did not significantly affect the composite outcome of death, recurrent MI, re-intervention, and major bleeding compared to continuing ticagrelor (4.6% vs 8.3%, p=0.23).
Why the study?
The pattern of ticagrelor use and the clinical effect of switching to other P2Y12 inhibitors in patients with ACS undergoing PCI required evaluation.
Does switching from ticagrelor to other P2Y12 inhibitors affect clinical outcomes in patients with acute coronary syndrome undergoing PCI?
Observational (n=321)
No
Does switching from ticagrelor to other P2Y12 inhibitors affect clinical outcomes in patients with acute coronary syndrome undergoing PCI?
In a real-world cohort of ACS patients undergoing PCI, early discontinuation of ticagrelor and switching to other P2Y12 inhibitors (predominantly clopidogrel) did not adversely affect clinical outcomes compared to continuation.
BACKGROUND: Dual antiplatelet therapy is the current standard of care after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). We intended to study the pattern of use of ticagrelor in patients with acute coronary syndrome undergoing PCI and the effect of switching over to other P2Y12 receptor inhibition on clinical outcomes. RESULTS: All patients aged > 18 years who had been admitted with acute coronary syndrome and had been provided ticagrelor as the second antiplatelet agent were included as study participants. The primary outcome of the study was the composite outcome of death, recurrent myocardial infarctions, re-intervention, and major bleeding. We studied 321 patients (54 female patients, 16.82%). The mean age of the patients was 56.65 ± 11.01 years. Ticagrelor was stopped in 76.7% on follow-up. It was stopped in 6.3%, 13.5%, 13.1%, 21.9%, and 45.1% of patients during the first month but after discharge, between first and third months, between 3 and 6 months, between 6 and 12 months, and after 12 months, respectively. In the majority of patients, ticagrelor was replaced by clopidogrel (97.9%). It was stopped according to the physician's discretion in 79.3% of patients, whereas it was the cost of the drug that made the patient to get swapped to another agent in 18.6%. No difference in the primary composite outcome was observed between the groups where ticagrelor was continued post 12 months and ticagrelor was continued and ticagrelor was switched-over to another agent. Similarly, no difference in death, recurrent myocardial infarctions, re-interventions, or major bleeding manifestations was observed between the two groups. CONCLUSION: In patients with acute coronary syndrome who undergo PCI, we observed that early discontinuation of ticagrelor and switching over to other P2Y12 inhibitors after discharge did not affect clinical outcomes.
No takes yet. Share an insight, caveat, or question.
Senguttuvan et al. (2021) conducted an observational in Acute coronary syndrome (n=321). Early discontinuation of ticagrelor and switching to other P2Y12 agents vs. Continuation of ticagrelor was evaluated on Composite of death, recurrent myocardial infarctions, re-intervention, and major bleeding (p=0.23). Early discontinuation of ticagrelor and switching to other P2Y12 inhibitors did not significantly affect the composite outcome of death, recurrent MI, re-intervention, and major bleeding compared to continuing ticagrelor (4.6% vs 8.3%, p=0.23).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: