Abstract 18728: Patterns of Antiplatelet Use in Patients With Stable Atherosclerosis: Insights From the Tra 2°P-timi 50 Trial
Background: Oral antiplatelet (AP) therapy is broadly supported as preventive therapy for patients with established atherosclerotic vascular disease; however, emerging evidence for specific agents show heterogeneous outcomes by symptomatic vascular bed. Patterns of use may vary by symptomatic territory.
Methods: We examined patterns of AP use at baseline in 26,449 stable outpatients randomized in the TRA 2° P-TIMI 50 trial including 17,779 with history of myocardial infarction (MI), 4,883 with history of ischemic stroke (CVD), and 3,787 with peripheral artery disease (PAD).
Results: Overall 24,734 (94%) of patients were on aspirin (ASA). In the MI cohort 17448 (98%) were treated with aspirin and the majority (76%) were treated with dual AP therapy with aspirin and a thienopyridine (DAPT) (fig). Within the CVD group overall AP use was frequent (98%) with the majority on monotherapy (70%) with either ASA (54%) or thienopyrdine (16%) (fig). Of those on multi-agent therapy (28%) the combination of ASA and dipyridamole was more frequent then DAPT (19% vs 7%). Within the PAD group AP therapy was also frequent (97%) with a similar proportion on monotherapy (69%) with either ASA (60%) or thienopyridine (9%). In those on multi-agent therapy, DAPT was the most frequent (28%) followed by the combination of ASA and cilostazol (11%) (fig).
Conclusions: Although atherosclerosis is a systemic disease and data supporting the use of antiplatelet therapy has often evaluated benefit broadly, in practice the distribution of agent and the intensity vary by symptomatic vascular territory. These patterns reflect emerging heterogeneity in outcomes trials evaluating specific therapies by symptomatic bed and support further evaluation of the risks and benefits in these specific populations.
- © 2013 by American Heart Association, Inc.