TY  - BOOK
AU  - Ben-Dor, Itsik
AU  - Buchanan, Kyle
AU  - Gajanana, Deepakraj
AU  - Iantorno, Micaela
AU  - Kolm, Paul
AU  - Okubagzi, Petros
AU  - Pichard, Augusto D
AU  - Rogers, Toby
AU  - Satler, Lowell F
AU  - Thourani, Vinod H
AU  - Torguson, Rebecca
AU  - Waksman, Ron
AU  - Weintraub, William S
TI  - The impact of in-hospital P2Y12 inhibitor switch in patients with acute coronary syndrome
SN  - 1878-0938
PY  - 2018///
KW  - *Acute Coronary Syndrome/th [Therapy]
KW  - *Drug-Eluting Stents
KW  - *Peptide Fragments/tu [Therapeutic Use]
KW  - *Percutaneous Coronary Intervention/mt [Methods]
KW  - *Purinergic P2Y Receptor Antagonists/tu [Therapeutic Use]
KW  - *Thrombolytic Therapy/mt [Methods]
KW  - *Warfarin/tu [Therapeutic Use]
KW  - Aged
KW  - Antithrombins/tu [Therapeutic Use]
KW  - Drug Substitution
KW  - Female
KW  - Follow-Up Studies
KW  - Hirudins
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - Recombinant Proteins/tu [Therapeutic Use]
KW  - Retrospective Studies
KW  - Treatment Outcome
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available in print through MWHC library: 2002 - present
N2  - 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; 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; Copyright (c) 2018 Elsevier Inc. All rights reserved; 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); 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); 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
UR  - https://dx.doi.org/10.1016/j.carrev.2018.09.007
ER  -