title: Contraindications/special warnings and precautions for use of contemporary oral antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention.
abstract: BACKGROUND
  The prevalence of contraindications/special warnings and precautions (CON/SWP) for clopidogrel, prasugrel and ticagrelor use is not adequately studied and might affect P2Y12 inhibitor choice in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).
  
  
  RESULTS
  In the context of the GReek AntiPlatelet rEgistry (GRAPE) a detailed recording of CON/SWP for use of clopidogrel, prasugrel and ticagrelor was done for 1,280 consecutive, moderate-high-risk ACS patients undergoing PCI. At least 1 CON for use of clopidogrel, prasugrel and ticagrelor was present in 5 (0.4%), 49 (3.8%) and 12 patients (0.9%), respectively. Prevalence of at least 1 CON/SWP to clopidogrel (45.8%) was less frequent compared to prasugrel (49.1%) or ticagrelor (49.1%; P=0.02 and P=0.04, respectively), while 34% of patients had at least 1 CON/SWP to all the 3 P2Y12 inhibitors. At discharge, 482 (38.6%), 301 (24.1%) and 464 patients (37.2%) received clopidogrel, prasugrel and ticagrelor, respectively. Age ≥75 years, co-medication related to increased bleeding risk, and history of asthma/chronic obstructive pulmonary disease favored clopidogrel vs. prasugrel or ticagrelor use as discharge medication, while geographic region also affected this choice (C-statistic, 0.81; 95% CI: 0.78-0.83).
  
  
  CONCLUSIONS
  In patients with ACS undergoing PCI the prevalence of CON to antiplatelet agents is low, whereas that of SWP is high. Certain SWP, along with regional trends may affect the choice of newer P2Y12 inhibitors vs. clopidogrel.
authors.affiliation: Department of Cardiology, Patras University Hospital.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
authors.forename: Ioanna
authors.initials: I
authors.lastname: Xanthopoulou
authors.forename: Spyridon
authors.initials: S
authors.lastname: Deftereos
authors.forename: George
authors.initials: G
authors.lastname: Sitafidis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kanakakis
authors.forename: Michalis
authors.initials: M
authors.lastname: Hamilos
authors.forename: Manolis
authors.initials: M
authors.lastname: Vavuranakis
authors.forename: Periklis
authors.initials: P
authors.lastname: Davlouros
authors.forename: Ioannis
authors.initials: I
authors.lastname: Ntalas
authors.forename: Christos
authors.initials: C
authors.lastname: Angelidis
authors.forename: George
authors.initials: G
authors.lastname: Hahalis
authors.forename: Filippos
authors.initials: F
authors.lastname: Triposkiadis
authors.forename: Panos
authors.initials: P
authors.lastname: Vardas
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
authors.forename: John A
authors.initials: JA
authors.lastname: Goudevenos
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000601:surgery; D000284:Administration, Oral; D000367:Age Factors; D000368:Aged; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D058925:Receptors, Purinergic P2Y12 / Q000097:blood; D012042:Registries
chemical_list: C548576:P2RY12 protein, human; D010975:Platelet Aggregation Inhibitors; D058925:Receptors, Purinergic P2Y12