Switching of adenosine diphosphate receptor inhibitor after hospital discharge among myocardial infarction patients: Insights from the Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome (TRANSLATE-ACS) observational study

The reasons for postdischarge adenosine diphosphate receptor inhibitor (ADPri) switching among patients with myocardial infarction (MI) are unclear. We sought to describe the incidence and patterns of postdischarge ADPri switching among patients with acute MI treated with percutaneous coronary inter...

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Veröffentlicht in:The American heart journal 2017-01, Vol.183, p.62-68
Hauptverfasser: Zettler, Marjorie E., Peterson, Eric D., McCoy, Lisa A., Effron, Mark B., Anstrom, Kevin J., Henry, Timothy D., Baker, Brian A., Messenger, John C., Cohen, David J., Wang, Tracy Y.
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container_issue
container_start_page 62
container_title The American heart journal
container_volume 183
creator Zettler, Marjorie E.
Peterson, Eric D.
McCoy, Lisa A.
Effron, Mark B.
Anstrom, Kevin J.
Henry, Timothy D.
Baker, Brian A.
Messenger, John C.
Cohen, David J.
Wang, Tracy Y.
description The reasons for postdischarge adenosine diphosphate receptor inhibitor (ADPri) switching among patients with myocardial infarction (MI) are unclear. We sought to describe the incidence and patterns of postdischarge ADPri switching among patients with acute MI treated with percutaneous coronary intervention. We used TRANSLATE-ACS (2010-2012) data to assess postdischarge ADPri switching among 8,672 MI patients discharged after percutaneous coronary intervention who remained on ADPri therapy 1 year post-MI. We examined patient-reported reasons for switching, GUSTO moderate or severe bleeding, major adverse cardiovascular events (MACEs), and definite stent thrombosis events around the time of the switch. Among patients still on ADPri therapy 1 year post-MI, 663 (7.6%) switched ADPri during that year. Switching occurred at a median of 50 days postdischarge and most frequently in patients discharged on ticagrelor (64/226; 28.3%), followed by prasugrel (383/2,489; 15.4%) and clopidogrel (216/5,957; 3.6%) (P < .001). Among patients discharged on prasugrel, 97.3% of switches were to clopidogrel and 87.5% of ticagrelor switches were to clopidogrel; both of these groups most often cited cost as a reason for switching (43.6% and 39.1%, respectively), whereas 60.7% who switched from clopidogrel cited physician decision as a reason. In the 7 days preceding the switch from clopidogrel, 40 (18.5%) had a MACE and 12 (5.6%) had a definite stent thrombosis event, whereas that from prasugrel or ticagrelor, a GUSTO moderate or severe bleeding event occurred in 1 (0.3%) and 0 patients, respectively. Postdischarge ADPri switching occurred infrequently within the first year post-MI and uncommonly was associated with MACEs or bleeding events.
doi_str_mv 10.1016/j.ahj.2016.10.006
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We sought to describe the incidence and patterns of postdischarge ADPri switching among patients with acute MI treated with percutaneous coronary intervention. We used TRANSLATE-ACS (2010-2012) data to assess postdischarge ADPri switching among 8,672 MI patients discharged after percutaneous coronary intervention who remained on ADPri therapy 1 year post-MI. We examined patient-reported reasons for switching, GUSTO moderate or severe bleeding, major adverse cardiovascular events (MACEs), and definite stent thrombosis events around the time of the switch. Among patients still on ADPri therapy 1 year post-MI, 663 (7.6%) switched ADPri during that year. Switching occurred at a median of 50 days postdischarge and most frequently in patients discharged on ticagrelor (64/226; 28.3%), followed by prasugrel (383/2,489; 15.4%) and clopidogrel (216/5,957; 3.6%) (P &lt; .001). 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ispartof The American heart journal, 2017-01, Vol.183, p.62-68
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1097-6744
language eng
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source MEDLINE; ScienceDirect Journals (5 years ago - present); ProQuest Central UK/Ireland
subjects Acute coronary syndromes
Adenosine - analogs & derivatives
Adenosine - therapeutic use
Adenosine Diphosphate
Aged
Cardiovascular Diseases - epidemiology
Coronary vessels
Data collection
Drug Substitution - statistics & numerical data
Family medical history
Female
Heart attacks
Hemorrhage - chemically induced
Humans
Longitudinal Studies
Male
Medical records
Middle Aged
Mortality
Myocardial Infarction - drug therapy
Patient Discharge
Patient Preference
Patients
Platelet Aggregation Inhibitors - therapeutic use
Prasugrel Hydrochloride - therapeutic use
Purinergic P1 Receptor Antagonists - adverse effects
Purinergic P1 Receptor Antagonists - economics
Purinergic P1 Receptor Antagonists - therapeutic use
Thrombosis
Ticlopidine - analogs & derivatives
Ticlopidine - therapeutic use
Variables
Veins & arteries
title Switching of adenosine diphosphate receptor inhibitor after hospital discharge among myocardial infarction patients: Insights from the Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome (TRANSLATE-ACS) observational study
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