Research from MedStar Washington Hospital Center and the National Institutes of Health (NIH) studied patient characteristics and predictors that may impact patient outcomes of changing the blood thinner medications that are used to prevent stroke, heart attack, and other heart problems. The study looked at the switching, either in-hospital or at discharge, from clopidogrel (CLO) to ticagrelor (TIC) or vice versa.
The goal of “The Impact of In-Hospital P2Y12 Inhibitor Switch in Patients with Acute Coronary Syndrome” was to examine the patient characteristics, frequency, and in-hospital clinical outcomes associated with switching between the P2Y12 inhibitors. P2Y12 inhibitors are anti-platelet medications that reduce the risk of clotting in arteries.
Published in Cardiovascular Revascularization Medicine, this study sought to evaluate the experience of patients with Acute Coronary Syndrome (ACS) who undergo a non-surgical procedure to treat narrowing of the coronary arteries of the heart found in coronary artery disease. This procedure is most commonly known as percutaneous coronary intervention.
The study identified 2837 patients with acute coronary syndrome who received drug-eluting stents and started dual antiplatelet therapy (DAPT). The study population received either CLO or TIC and was divided into 4 groups based on initial DAPT choice and whether treatment was switched in-hospital or during discharge. There were no significant differences between the two switched groups, except prior history of coronary artery disease and hypertension.
The study found several factors that would determine switching between P2Y12 inhibitors. Clinical needs determine if in-hospital switching occurs, and was found in approximately 9% of the acute coronary syndrome population with drug-eluting stents. Also, the ACS patient population may experience a need for in-hospital coronary artery bypass graft or oral anticoagulation upon discharge as a factor for switching. The costs of drug, adverse effects, bleeding, allergy to the medication, and physician preference are other potential reasons for switching medication.
“Our study was underpowered to look at outcome events,” the study concluded. “Our findings could serve as hypothesis generation for larger studies with greater power.”
The study team included Deepakraj Gajanana, MD; William S. Weintraub, MD; Paul Kolm, PhD; Micaela Iantorno, MD; Kyle D. Buchanan, MD; Itsik Ben-Dor, MD; Augusto D. Pichard, MD; Lowell F. Satler, MD; Vinod H. Thourani, MD; Rebecca Torguson, MPH; Petros G. Okubagzi, MD; Ron Waksman, MD and Toby Rogers, MD with the MedStar Cardiovascular Research Network, Section of Interventional Cardiology and Department of Cardiac Surgery at MedStar Washington Hospital Center. Dr. Rogers is also affiliated with the National Institutes of Health.
Cardiovascular Revascularization Medicine, 2018. DOI: 10.1016/j.carrev.2018.09.007