Incidence, predictors, and prognosis of premature discontinuation or switch of prasugrel or ticagrelor: the ATLANTIS - SWITCH study.
Max-Paul WinterDirk von LewinskiMarkus WallnerFlorian PrüllerEwald KolesnikChristian HengstenbergJolanta M Siller-MatulaPublished in: Scientific reports (2019)
Aim of the present study was to investigate the frequency and predictors of premature discontinuation or switch of ADP receptor blockers and its association with serious adverse events. For this purpose 571 consecutive ACS patients receiving ticagrelor (n = 258, 45%) or prasugrel (n = 313, 55%) undergoing PCI were enrolled in this prospective, observational, multicenter ATLANTIS-SWITCH substudy. Predictors of premature discontinuation or switch of antiplatelet therapy and their association with major adverse cardiovascular events and TIMI bleeding events were evaluated. Premature stop/switch was found in 72 (12.6%) patients: 34 (5.9%) stopped and 38 (6.7%) switched the ADP blocker. Ticagrelor treated patients were significantly more likely to stop/switch therapy as compared to prasugrel (15.9% vs. 9.2%, p = 0.016). We identified 4 independent predictors for stop/switch of ADP blocker: major surgery, need for oral anticoagulation (OAC), TIMI major bleeding and drug intolerance. TIMI major bleeding was a driver of stop/switch actions and occurred in 4.3% vs 0.2% in patients with vs without stop/switch (p = 0.001). The majority of stop/switch actions (75%) were physicians driven decisions. Importantly, stop/switch of therapy was not associated with increased risk of MACE (p = 0.936). In conclusion premature switch/stop of ADP blockers appears to be safe when mainly driven by physician's decision and clinical indication.
Keyphrases
- percutaneous coronary intervention
- antiplatelet therapy
- acute coronary syndrome
- cardiovascular events
- atrial fibrillation
- st segment elevation myocardial infarction
- newly diagnosed
- coronary artery disease
- st elevation myocardial infarction
- ejection fraction
- emergency department
- cardiovascular disease
- heart failure
- acute myocardial infarction
- prognostic factors
- coronary artery bypass grafting
- type diabetes
- clinical trial
- angiotensin ii
- left ventricular
- cell therapy
- double blind
- electronic health record
- decision making