Abstract 11821: An International Perspective of Current Patterns of Antiplatelet Drug Use in Acute Coronary Syndrome Patients. Results from the EPICOR Study

Abstract

Purpose. To describe the current patterns of utilization of antiplatelet therapies (AT) before and during hospitalization for acute coronary syndromes (ACS).

Methods. EPICOR (NCT01171404) is a prospective international observational study (10,568 patients enrolled in 555 primary, secondary and tertiary care hospitals in 20 countries across Europe and Latin America between September 1, 2010, and March 31, 2011, prior to availability of ticagrelor) designed to describe current use of AT before, during and after hospitalization in a broad ACS population. This is the descriptive analysis of the patterns of AT use in the acute phase of ACS care (before hospital discharge).

Results. Of all possible combinations, most patients were treated with aspirin (A) and clopidogrel (C) (n=7369, 69.7%), followed by triple AT (TAT) (n=1706, 16.1%) with either A+C+GPIIb/IIIa inhibitors (GPI), or A+prasugrel (P)+GPI. Other ATs included P±A (572, 5.4%), A alone±GPI (559, 5.3%), and C alone±GPI (292, 2.8%). Overall, patients treated with TAT or P±A were significantly younger than those treated with other AT (59±11 and 57±11 years, respectively, compared with 63±12 years, p<.001 for both comparisons). Significant differences in the use of TAT, DAT and single AT were found for STEMI vs NSTE ACS patients (p<.001), and according to the use of reperfusion therapy (Rep) and its types: primary PCI (PPCI) vs thrombolytic therapy (TT) in STEMI patients (p<.001), and invasive vs conservative strategy in NSTEACS patients (p <.001).

Conclusions. A+C is still the most frequently prescribed acute AT for ACS, regardless of management strategy. However, there is considerable variability in the use of other ATs for ACS patients, which is only partially explained by type of ACS and management strategy.