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Am Heart J. 2014 Jan;167(1):68-76.e2. doi: 10.1016/j.ahj.2013.10.010. Epub 2013 Oct 22.

In-hospital switching of oral P2Y12 inhibitor treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention: prevalence, predictors and short-term outcome.

Author information

1
Department of Cardiology, Patras University Hospital, Patras, Greece. Electronic address: dalex@med.upatras.gr.
2
Department of Cardiology, Patras University Hospital, Patras, Greece.
3
Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece.
4
Department of Cardiology, Larissa University Hospital, Larissa, Greece.
5
Department of Clinical Therapeutics, "Alexandra" University Hospital, Athens, Greece.
6
Department of Cardiology, Iraklion University Hospital, Iraklion, Greece.
7
Department of Cardiology, Alexandroupolis University Hospital, Alexandroupolis, Greece.
8
1st University Department of Cardiology, Ippokration Hospital, Athens, Greece.
9
Department of Cardiology, Ioannina University Hospital, Ioannina, Greece.

Abstract

BACKGROUND:

P2Y12 inhibitor switching has appeared in clinical practice as a consequence of prasugrel and ticagrelor availability, apart from clopidogrel, for use in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

METHODS:

In the context of the GReek AntiPlatelet REgistry (GRAPE) we assessed the prevalence, predictive factors and short-term outcome of in-hospital P2Y12 inhibitor switching in 1794 ACS patients undergoing PCI.

RESULTS:

Switching occurred in 636 (35.5%) patients of which in the form of clopidogrel to a novel agent, novel agent to clopidogrel and between prasugrel and ticagrelor in 574 (90.4%), 34 (5.3%) and 27 (4.3%) patients, respectively. Presentation to non PCI-capable hospital, bivalirudin use, age ≥75 years (inverse predictor), and regional trends emerged as predictive factors of switching to a novel agent. At combined in-hospital and one-month follow-up, propensity matched pairs analysis showed no differences in major adverse cardiovascular (MACE) or bleeding events between switching from clopidogrel to a novel agent vs novel agent constant administration. More Bleeding Academic Research Consortium type 1, type 2 and any type events and fewer MACE were seen when switching from clopidogrel to a novel agent vs only clopidogrel administration (23.7%, 3.8%, 30.6%, 1.2% vs 8.9%, 1.2%, 12.0%, 3.8% with P < .001, P = .03, P < .001 and P = .03 respectively).

CONCLUSIONS:

In a real-life experience with contemporary antiplatelet treatment in ACS patients undergoing PCI, in-hospital switching represents common clinical practice. Clinical factors and regional practice differences seem to affect this strategy's choice, while switching to a novel agent may be associated with higher risk of bleeding.

PMID:
24332144
DOI:
10.1016/j.ahj.2013.10.010
[Indexed for MEDLINE]

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