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The impact of in-hospital P2Y12 inhibitor switch in patients with acute coronary syndrome.

by Gajanana, Deepakraj; Weintraub, William S; Kolm, Paul; Rogers, Toby; Iantorno, Micaela; Buchanan, Kyle; Ben-Dor, Itsik; Pichard, Augusto D; Satler, Lowell F; Thourani, Vinod H; Torguson, Rebecca; Okubagzi, Petros; Waksman, Ron.
Citation: Cardiovascular Revascularization Medicine. 2018 Sep 11.Journal: Cardiovascular revascularization medicine : including molecular interventions.Published: ; 2018ISSN: 1878-0938.Full author list: Gajanana D; Weintraub WS; Kolm P; Rogers T; Iantorno M; Buchanan KD; Ben-Dor I; Pichard AD; Satler LF; Thourani VH; Torguson R; Okubagzi PG; Waksman R.UI/PMID: 30243963.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: (Click here) Abbreviated citation: Cardiovasc Revasc Med. 2018 Sep 11.Local Holdings: Available in print through MWHC library: 2002 - present.Abstract: BACKGROUND/PURPOSE: Dual antiplatelet therapy (DAPT) varies after placement of drug-eluting stents (DES) in patients presenting with acute coronary syndromes (ACS). Our aim was to study patient characteristics and predictors of switching, in-hospital or at discharge, from clopidogrel (CLO) to ticagrelor (TIC) or vice versa.Abstract: METHODS/MATERIALS: The study population included patients with ACS who had DES and initially received either CLO or TIC between January 2011 and December 2017. Patients were divided into 4 groups based on initial DAPT choice and whether DAPT was switched in-hospital or during discharge. Clinical outcomes of interest were bleeding events, need for anticoagulation, and need for in-hospital coronary artery bypass graft (CABG).Abstract: RESULTS: We identified 2837 patients who received DES and started on DAPT. DAPT switch from 1 P2Y12 inhibitor to another occurred in 9%, either in-hospital or at discharge. Of 1834 patients started on CLO, 112 were switched to TIC. Of 1003 patients started on TIC, 142 were switched to CLO. The need for in-hospital CABG was 7.8% in the TIC-CLO group compared to none in the CLO-TIC group (p=0.002). Adjusted for covariates, the TIC-CLO group was 3 times more likely to need anticoagulation with warfarin than the CLO-CLO group (p<0.001) and over 5 times more likely than the CLO-TIC group and the TIC-TIC group (p<0.005 for both).Abstract: CONCLUSIONS: Switching from 1 generation P2Y12 inhibitor to another does occur in ACS patients. Clinical needs such as in-hospital CABG or oral anticoagulation upon discharge are real and dictate the switch from TIC to CLO.Abstract: SUMMARY: A single-center observational study of 2837 patients with acute coronary syndromes treated with drug-eluting stents found that some do get switched from one generation P2Y12 inhibitor to another. The switch from clopidogrel to ticagrelor is driven by clinical needs such as in-hospital coronary artery bypass grafting or the need for oral anticoagulation upon discharge.Abstract: Copyright (c) 2018 Elsevier Inc. All rights reserved.

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