Clopidogrel, prasugrel or ticagrelor in patients with acute coronary syndromes undergoing percutaneous coronary intervention

Yudi, MB, Clark, DJ, Farouque, O, Eccleston, D, Andrianopoulos, N, Duffy, SJ, Brennan, A, Lefkovits, J, Ramchand, J, Yip, T, Oqueli, E, Reid, CM, Ajani, AE, New, G, Hiew, C, Shaw, JA, Walton, A, Dart, A, Broughton, A, Federman, J, Keighley, C, Hengel, C, Peter, KH, O'Brien, J, Bala, H, Selkrig, L, Vandernet, R, Huntington, R, Horrigan, M, Johns, J, Oliver, L, Brennan, J, Chan, R, Proimos, G, Dortimer, T, Chan, B, Nadurata, V, Huq, R, Fernando, D, Charter, K, Brown, L, AlFiadh, A, Sugumar, H, Spencer, R, Scott, P, Ryan, N, Barry, C, Roberts, L, Freeman, M, Teh, A, Rowe, M, Cheong, Y, Goods, C, Baradi, A, Jackson, D, Sajeev, J, Lew, R, Szto, G, Teperman, R, Sebastian, M, Mok, Michael, Rankin, K, Machado, C, Dyson, J, McDonald, B, Duff, L, Krum, H, Chand, V, Dinh, D, Yan, BP, Warren, R, Iyer, R, Gurvitch, R, Wilson, W, Brooks, M, Biswas, S, Yeoh, J, Cheshire, C and Gaikwad, N 2016, Clopidogrel, prasugrel or ticagrelor in patients with acute coronary syndromes undergoing percutaneous coronary intervention, Internal medicine journal, vol. 46, no. 5, pp. 559-565, doi: 10.1111/imj.13041.

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Title Clopidogrel, prasugrel or ticagrelor in patients with acute coronary syndromes undergoing percutaneous coronary intervention
Author(s) Yudi, MB
Clark, DJ
Farouque, O
Eccleston, D
Andrianopoulos, N
Duffy, SJ
Brennan, A
Lefkovits, J
Ramchand, J
Yip, T
Oqueli, E
Reid, CM
Ajani, AE
New, G
Hiew, C
Shaw, JA
Walton, A
Dart, A
Broughton, A
Federman, J
Keighley, C
Hengel, C
Peter, KH
O'Brien, J
Bala, H
Selkrig, L
Vandernet, R
Huntington, R
Horrigan, M
Johns, J
Oliver, L
Brennan, J
Chan, R
Proimos, G
Dortimer, T
Chan, B
Nadurata, V
Huq, R
Fernando, D
Charter, K
Brown, L
AlFiadh, A
Sugumar, H
Spencer, R
Scott, P
Ryan, N
Barry, C
Roberts, L
Freeman, M
Teh, A
Rowe, M
Cheong, Y
Goods, C
Baradi, A
Jackson, D
Sajeev, J
Lew, R
Szto, G
Teperman, R
Sebastian, M
Mok, MichaelORCID iD for Mok, Michael orcid.org/0000-0003-1839-2316
Rankin, K
Machado, C
Dyson, J
McDonald, B
Duff, L
Krum, H
Chand, V
Dinh, D
Yan, BP
Warren, R
Iyer, R
Gurvitch, R
Wilson, W
Brooks, M
Biswas, S
Yeoh, J
Cheshire, C
Gaikwad, N
Journal name Internal medicine journal
Volume number 46
Issue number 5
Start page 559
End page 565
Total pages 7
Publisher Wiles
Place of publication Chichester, Eng.
Publication date 2016-05
ISSN 1444-0903
1445-5994
Keyword(s) acute coronary syndrome
antiplatelet agent
clopidogrel
prasugrel
ticagrelor
Melbourne Interventional Group
Summary Background: Guidelines recommend prasugrel or ticagrelor instead of clopidogrel in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary interventions (PCI). Aim: We sought to describe the trends in uptake of the newer agents and analyse the clinical characteristics and short-term outcomes of patients treated with clopidogrel, prasugrel or ticagrelor. Methods: We analysed the temporal trends of antiplatelet use since the availability of prasugrel (2009-2013) in patients with ACS from the Melbourne Interventional Group registry. To assess clinical characteristics and outcomes, we included 1850 patients from 2012 to 2013, corresponding to the time all three agents were available. The primary outcome was major adverse cardiovascular events (MACE). The safety end-point was in-hospital bleeding. Results: For the period of 2009-2013, the majority of patients were treated with clopidogrel (72%) compared with prasugrel (14%) or ticagrelor (14%). There was a clear trend towards ticagrelor by the end of 2013. Patients treated with clopidogrel were more likely to present with non-ST-elevation ACS, be older, and have more comorbidities. There was no difference in unadjusted 30-day mortality (0.9 vs 0.5 vs 1.0%, P = 0.76), myocardial infarction (2 vs 1 vs 2%, P = 0.52) or MACE (3 vs 3 vs 4%, P = 0.57) between the three agents. There was no difference in in-hospital bleeding (3 vs 2 vs 2%, P = 0.64). Conclusion: Prasugrel and ticagrelor are increasingly used in ACS patients treated with PCI, predominantly in a younger cohort with less comorbidity. Although antiplatelet therapy should still be individualised based on the thrombotic and bleeding risk, our study highlights the safety of the new P2Y12 inhibitors in contemporary Australian practice.
Language eng
DOI 10.1111/imj.13041
Field of Research 1102 Cardiorespiratory Medicine and Haematology
1103 Clinical Sciences
1117 Public Health and Health Services
HERDC Research category C1 Refereed article in a scholarly journal
Persistent URL http://hdl.handle.net/10536/DRO/DU:30147815

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
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