Abstract 16415: Switching of ADP Receptor Inhibitor After Hospital Discharge Among Myocardial Infarction Patients: Insights From the TRANSLATE-ACS Observational Study
Background: With the availability of several ADP receptor inhibitors (ADPri), switching between agents is known to occur. However, among myocardial infarction (MI) patients treated with percutaneous coronary intervention (PCI), the incidence and patterns of post-discharge ADPri switching are unknown.
Methods: Using data from the TRANSLATE-ACS study (2010-2012), we assessed the incidence of post-discharge ADPri switching among 8672 MI patients who were discharged after PCI and remained on ADPri therapy through 1 year post-MI. We examined bleeding and major adverse cardiovascular events (MACE: MI, stroke, unplanned revascularization) within 7 days before and after switching.
Results: During the first year after index MI discharge, 663 patients (7.6%) had a switch in ADPri; switching occurred at a median of 50 days (IQR 7-154) post-discharge. Switching occurred most frequently in patients discharged on ticagrelor (64/226, 28.3%), then prasugrel (383/2489, 15.4%), and clopidogrel (216/5957, 3.6%, p<0.001). Among patients discharged on prasugrel, 97.3% of switches were to clopidogrel; 87.5% of ticagrelor switches were to clopidogrel. Among clopidogrel patients who switched, 55 (25.5%) had a MACE event in the 7 days preceding switch. Among prasugrel and ticagrelor patients who switched, a GUSTO moderate/severe bleeding event occurred in 5 (1.3%) and 1 (1.5%) patients, respectively, in the 7 days preceding switch. Patients switched from prasugrel or ticagrelor most often cited cost as a reason for the switch (43.6% and 39.1%, respectively), while 60.7% of patients switched from clopidogrel attributed the switch to a physician decision. In the week following a switch, both MACE and major bleeding events were infrequent (table).
Conclusions: ADPri switching occurred infrequently within the first year post-MI. Switching occurred more commonly among patients discharged on higher potency ADPri, but only a minority of these switches were triggered by bleeding.
- Antiplatelet drugs
- Acute coronary syndromes
- Percutaneous coronary intervention (PCI)
Author Disclosures: M.E. Zettler: Employment; Significant; Eli Lilly & Company. E.D. Peterson: Research Grant; Modest; American College of Cardiology, American Heart Association, Eli Lilly, Janssen. Consultant/Advisory Board; Modest; Merck & Co., Boehringer Ingelheim, Genentech, Janssen, Sanofi-Aventis. L.A. McCoy: None. M.B. Effron: Employment; Significant; Eli Lilly & Company. Other; Modest; Shareholder, Eli Lilly & Company. K.J. Anstrom: Research Grant; Significant; AstraZeneca, Bristol-Meyers Squibb, Eli Lilly & Company, Boehringer Ingelheim, Pulmonary Fibrosis Foundation and Medtronic. Ownership Interest; Modest; Biscardia. Consultant/Advisory Board; Modest; Abbott Vascular, AstraZeneca, Bristol-Meyers Squibb, Gilead, Pfizer, and GlaxoSmithKline. Other; Modest; Data monitoring committees for NIH, Forest, Pfizer, and GlaxoSmithKline. T.D. Henry: Honoraria; Modest; Eli Lilly & Company and Daiichi Sankyo. B.A. Baker: Employment; Significant; Daiichi Sankyo Inc.. J.C. Messenger: None. D.J. Cohen: Research Grant; Modest; Eli Lilly & Company, Daiichi Sankyo, Astra Zeneca. Honoraria; Modest; AstraZeneca. Consultant/Advisory Board; Modest; Eli Lilly & Company, AstraZeneca. T.Y. Wang: Research Grant; Modest; Bristol Myers Squibb. Honoraria; Modest; Astra Zeneca <10K, Eli Lilly <10, Premier <10. Research Grant; Significant; Eli LIlly, Daiichi Sankyo, Gilead Science, Glaxo Smith Kline, AstraZeneca, Boston Scientific, Regeneron.
- © 2015 by American Heart Association, Inc.