Advertisement

Clinical Drug Investigation

, Volume 39, Issue 3, pp 275–283 | Cite as

Switching of Oral P2Y12 Inhibitor Treatment in Patients with Acute Coronary Syndrome: Prevalence, Predictors, and Prognosis

  • Luna Carrillo-AlemanEmail author
  • Francisco Marín
  • José M. Rivera-Caravaca
  • Nuria Vicente-Ibarra
  • Elena Candela-Sanchez
  • Maria A. Esteve-Pastor
  • Teresa Lozano
  • Miriam Sandín-Rollan
  • Vicente Pernias-Escrig
  • Manuel Macías
  • Miriam Quintana-Giner
  • Andrea Veliz
  • Esteban Orenes-Piñero
  • Juan G. Martínez-Martínez
  • Juan M. Ruiz-Nodar
Original Research Article
  • 71 Downloads

Abstract

Background and Objective

Dual antiplatelet therapy is one of the main treatments in acute coronary syndrome (ACS). Switching antiplatelet agents may be necessary in some patients to improve efficacy or safety. The objective of this study was to determine the prevalence, predictors, and implications of clinical switching in patients during hospital admission and 1-year follow-up at discharge.

Methods

Observational, prospective, multicenter registry study in patients discharged following an admission for ACS and followed up for 1 year. We analyzed ischemic and bleeding events as well as treatment changes.

Results

We recruited 1717 patients; in-hospital switching occurred in 425 (24.8%): 15.1% to clopidogrel and 84.9% to newer antiplatelet drugs (prasugrel or ticagrelor). Those switched to newer antiplatelets were younger, with lower scores on the GRACE and CRUSADE scales, admitted more frequently for ST-elevation myocardial infarction and underwent more invasive management and percutaneous revascularization. The clinical cardiologist was responsible for most in-hospital switching to newer antiplatelets (79.6%). The loading dose of the second antiplatelet did not affect incidence of bleeding events. Post-discharge switching was infrequent (2%) and depended mainly on clinical indications; only 30% was related to a new ACS.

Conclusions

In a contemporary registry with ACS, in-hospital switching of antiplatelet drugs was frequent. Those switched to newer antiplatelets were younger and admitted more frequently for ST-elevation myocardial infarction. Post-discharge switching was infrequent.

Notes

Acknowledgements

This work was supported by the Spanish Society of Cardiology (Project of Clinical Research in Cardiology Dr. Pedro Zarco 2016).

Compliance with Ethical Standards

Funding

No sources of funding.

Conflict of interest

The authors report no conflicts of interest.

Ethics approval

All procedures in this study were in accordance with the 1964 Helsinki Declaration (and its amendments), and the requirements of the Ethics Committee or Institutional Review Board that approved the study.

Informed consent

Written informed consent was obtained from all patients.

References

  1. 1.
    James S, Akerblom A, Cannon CP, Emanuelsson H, Husted S, Katus H, et al. Comparison of ticagrelor, the first reversible oral P2Y12 receptor antagonist, with clopidogrel in patients with acute coronary syndromes: rationale, design, and baseline characteristics of the Platelet Inhibition and Patient Outcomes (PLATO) trial. Am Heart J. 2009;157:599–605.CrossRefPubMedGoogle Scholar
  2. 2.
    Hochholzer W, Wiviott SD, Antman EM, Contant CF, Guo J, Giugliano RP, et al. Predictors of bleeding and time dependence of association of bleeding with mortality: insights from the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis in Myocardial Infarction 38 (TRITON-TIMI 38). Circulation. 2011;123:2681–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Alexopoulos D, Xanthopoulou I, Deftereos S, Sitafidis G, Kanakakis I, Hamilos M, et al. In-hospital switching of oral P2Y12 inhibitor treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention: Prevalence, predictors and short-term outcome. Am Heart J. 2014;167:68–76.CrossRefPubMedGoogle Scholar
  4. 4.
    Rollini F, Franchi F, Angiolillo DJ. Switching P2Y12 -receptor inhibitors in patients with coronary artery disease. Nat Rev Cardiol. 2016;13:11–27.CrossRefPubMedGoogle Scholar
  5. 5.
    Roffi M, Patrono C, Collet J-P, Mueller C, Valgimigli M, Andreotti F, et al. ESC. 2015 guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology. Eur Heart J. 2016;37:267–315.CrossRefPubMedGoogle Scholar
  6. 6.
    Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am CollCardiol. 2014;64:139–228.CrossRefGoogle Scholar
  7. 7.
    Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018;39:213–60.CrossRefPubMedGoogle Scholar
  8. 8.
    Angiolillo D, Rollini F, Storey R, Bhatt D, James S, Schneider D, et al. International expert consensus on switching platelet P2Y12 receptor inhibiting therapies. Circulation. 2017;136:1955–75.CrossRefPubMedGoogle Scholar
  9. 9.
    Esteve-Pastor MA, Ruiz-Nodar JM, Orenes-Piñero E, Rivera-Caravaca JM, Quintana-Giner M, Veliz A, et al. Temporal trends in the use of antiplatelet therapy in patients witch acute coronary syndromes. J Cardiovasc Pharmacol Ther. 2017;23(37):107424841772486.Google Scholar
  10. 10.
    Orenes-Piñero E, Ruiz-Nodar JM, Esteve-Pastor MA, Quintana-Giner M, Rivera-Caravaca JM, Veliz A, et al. Therapeutic management and one-year outcomes in elderly patients witch acute coronary syndrome. Oncotarget. 2017;8:80182–91.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Mehran R, Rao S, Bhatt D, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials. A consensus report from the bleeding academic research consortium. Circulation. 2011;123:2736–47.CrossRefPubMedGoogle Scholar
  12. 12.
    Bagai A, Wang Y, Wang TY, Curtis JP, Gurm HS, Shah B, et al. In-hospital switching between clopidogrel and prasugrel among patients with acute myocardial infarction treated with percutaneous coronary intervention: insights into contemporary practice from the national cardiovascular data registry. Circ Cardiovasc Interv. 2014;7:585–93.CrossRefPubMedGoogle Scholar
  13. 13.
    Bagai A, Peterson E, Honeycutt E, Effron M, Cohen D, Goodman S, et al. In-hospital switching between adenosine diphosphate receptor inhibitors in patients with acute myocardial infarction treated with percutaneous coronary intervention: insights intro contemporary practice from the TRANSLATE-ACS study. Eur Heat J Acute Cardiovasc Care. 2015;4(6):499–508.CrossRefGoogle Scholar
  14. 14.
    De Luca L, Leonardi S, Cavallini C, Lucci D, Musumeci G, Caporale R, et al. Contemporary antithrombotic strategies in patients with acute coronary syndrome admitted to cardiac care units in Italy: The EYESHOT Study. Eur Heart J Acute Cardiovasc Care. 2015;4:441–52.CrossRefPubMedGoogle Scholar
  15. 15.
    De Luca G, Verdoia M, Schaffer A, Suryapranata H, Parodi G, Antoniucci D, et al. Switching from high-dose clopidogrel to prasugrel in ACS patients undergoing PCI: a single-center experience. J Thromb Thrombolysis. 2014;38:388–94.CrossRefPubMedGoogle Scholar
  16. 16.
    Loh JP, Pendyala LK, Kitabata H, Torguson R, Chen F, Kent KM, et al. Safety of reloading prasugrel in addition to clopidogrel loading in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Am J Cardiol. 2013;111:841–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Bagai A, Chua D, Cohen EA, Saw J, Verma S, Vijayaraghavan R, et al. Pharmacodynamic and clinical implications of switching between P2Y12 receptor antagonists: considerations for practice. Crit Pathw Cardiol. 2014;13:156–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Almendro-Delia M, Blanco-Ponce E, Gomez-Domínguez R, Gonzalez-Matos C, Lobo-Gonzalez M, Caballero-Garcia A, et al. Safety and efficacy of in-hospital clopidogrel-to-prasugrel switching in patients with acute coronary syndrome. Analysis from the real world. J Thromb Thrombolysis. 2015;39:499–507.CrossRefPubMedGoogle Scholar
  19. 19.
    De Luca L, D’Ascenszo F, Musumeci G, Saia F, Parodi G, Varbella F, et al. Incidence and outcome of switching of oral platelet P2Y12 receptor inhibitors in patients with acute coronary syndromes undergoing percutaneous coronary intervention: the SCOPE registry. EuroIntervention. 2017;13(4):459–66.CrossRefPubMedGoogle Scholar
  20. 20.
    Azmoon S, Angiolillo D. Switching antiplatelet regimens: alternative to clopidogrel in patients with acute coronary syndrome undergoing PCI: a review of the literature and practical considerations for the interventional cardiologist. Cath Cardiovasc Interv. 2013;81:232–42.CrossRefGoogle Scholar
  21. 21.
    Angiolillo DJ, Saucedo J, Deerad R, Frelinger A, Gurbel P, Costigan T, et al. Increased platelet inhibitor after switching from maintenance clopidogrel to prasugrel in patients with acute coronary syndrome: results of the SWAP study. J Am Coll Cardiol. 2010;56:1017–23.CrossRefPubMedGoogle Scholar
  22. 22.
    Montalescot G, Sideris G, Cohen R, Meuleman C, Bal dit Sollier C, Bartheleny O, et al. Prasugrel compared with high-dose clopidogrel in acute coronary syndrome. The randomised double-blind ACAPULCO study. Thromb Haemost. 2010;103:213–23.CrossRefPubMedGoogle Scholar
  23. 23.
    Gurhl P, Blinden K, Antonino M, Wei C, Teng R, Rasmussen L, et al. Response to ticagrelor in clopidogrel nonresponders and responders and effect of switching therapies: the RESPOND study. Circulation. 2010;121:1188–99.CrossRefGoogle Scholar
  24. 24.
    Green A, Pottegård A, Broe A, Diness TG, Emneus M, Hasvold P, et al. Initiation and persistence with dual antiplatelet therapy after acute myocardial infarction: a Danish nationwide population-based cohort study. BMJ Open. 2016;6:e010880.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Yamaç AH, Göktekin O. Switching from clopidogrel to prasugrel: Efficacy and safety data. Turk Kardiyol Dern Ars. 2015;43:20–4.PubMedGoogle Scholar
  26. 26.
    Franchi F, Rolini F, Rivas Rios J, Rivas A, Agarwal M, Kureti M, et al. Pharmacodynamic effects of switching from ticagrelor to clopidogrel in patients with coronary artery disease: results of the SWAP-4 study. Circulation. 2018;137(23):2450–62.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Luna Carrillo-Aleman
    • 1
    Email author
  • Francisco Marín
    • 2
  • José M. Rivera-Caravaca
    • 2
  • Nuria Vicente-Ibarra
    • 3
  • Elena Candela-Sanchez
    • 1
  • Maria A. Esteve-Pastor
    • 3
  • Teresa Lozano
    • 1
  • Miriam Sandín-Rollan
    • 1
  • Vicente Pernias-Escrig
    • 2
  • Manuel Macías
    • 1
  • Miriam Quintana-Giner
    • 2
  • Andrea Veliz
    • 2
  • Esteban Orenes-Piñero
    • 2
  • Juan G. Martínez-Martínez
    • 1
  • Juan M. Ruiz-Nodar
    • 1
  1. 1.Department of CardiologyHospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL)AlicanteSpain
  2. 2.Department of CardiologyHospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación (IMIB-Arrixaca), CIBER-CVMurciaSpain
  3. 3.Department of CardiologyHospital General Universitario de ElcheAlicanteSpain

Personalised recommendations