Abstract 15573: In-Hospital Switching of ADP Receptor Inhibitors in Myocardial Infarction Patients Treated with Percutaneous Coronary Intervention: Insights from the TRANSLATE-ACS Study
Background: While several ADP receptor inhibitors are now available, little is known regarding patterns of drug switching and associated patient selection factors.
Methods: We studied ADP receptor inhibitor use among 6,362 MI patients treated with PCI at 196 hospitals from 4/2010-4/2012 in the TRANSLATE-ACS observational study. Clopidogrel/ticlopidine were defined as 1st generation and prasugrel/ticagrelor were defined as 2nd generation ADP receptor inhibitors.
Results: Among 4,778 patients initially treated with a 1st generation ADP receptor inhibitor, 491 (10%) were switched to a 2nd generation drug during the index hospitalization (63% switched after PCI and 26% at discharge). Among 1,584 patients initially treated with a 2nd generation ADP receptor inhibitor, 186 (12%) were switched to a 1st generation drug (48% switched after PCI and 48% at discharge). Compared with patients continued on a 1st generation drug, those switched to 2nd generation were more likely to be younger, male, privately insured, to present with STEMI, receive drug-eluting stents, and undergo platelet function testing, but were less likely to have prior stroke/TIA (Table). Compared with patients continued on a 2nd generation drug, those switched to 1st generation were older, less likely to be privately insured, and more likely to have a lower body weight, prior stroke/TIA, receive bare metal stents, and be discharged home on anticoagulants. No clinical differences were seen between groups in baseline physical function, predicted mortality risk, or frequency of multivessel PCI and in-hospital bleeding.
Conclusion: ADP receptor inhibitors are switched in approximately 10% of MI patients undergoing PCI during the index hospitalization. Drug switching appears to be associated with both clinical and socio-economic factors. Future studies will assess the longitudinal implications of ADP receptor inhibitor switching on ischemic and bleeding outcomes.
- © 2012 by American Heart Association, Inc.