title: In-hospital switching of oral P2Y12 inhibitor treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention: prevalence, predictors and short-term outcome.
abstract: BACKGROUND
  P2Y12 inhibitor switching has appeared in clinical practice as a consequence of prasugrel and ticagrelor availability, apart from clopidogrel, for use in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).
  
  
  METHODS
  In the context of the GReek AntiPlatelet REgistry (GRAPE) we assessed the prevalence, predictive factors and short-term outcome of in-hospital P2Y12 inhibitor switching in 1794 ACS patients undergoing PCI.
  
  
  RESULTS
  Switching occurred in 636 (35.5%) patients of which in the form of clopidogrel to a novel agent, novel agent to clopidogrel and between prasugrel and ticagrelor in 574 (90.4%), 34 (5.3%) and 27 (4.3%) patients, respectively. Presentation to non PCI-capable hospital, bivalirudin use, age ≥75 years (inverse predictor), and regional trends emerged as predictive factors of switching to a novel agent. At combined in-hospital and one-month follow-up, propensity matched pairs analysis showed no differences in major adverse cardiovascular (MACE) or bleeding events between switching from clopidogrel to a novel agent vs novel agent constant administration. More Bleeding Academic Research Consortium type 1, type 2 and any type events and fewer MACE were seen when switching from clopidogrel to a novel agent vs only clopidogrel administration (23.7%, 3.8%, 30.6%, 1.2% vs 8.9%, 1.2%, 12.0%, 3.8% with P < .001, P = .03, P < .001 and P = .03 respectively).
  
  
  CONCLUSIONS
  In a real-life experience with contemporary antiplatelet treatment in ACS patients undergoing PCI, in-hospital switching represents common clinical practice. Clinical factors and regional practice differences seem to affect this strategy's choice, while switching to a novel agent may be associated with higher risk of bleeding.
authors: Department of Cardiology, Patras University Hospital, Patras, Greece. Electronic address: dalex@med.upatras.gr.
authors: Dimitrios
authors: D
authors: Alexopoulos
authors: Department of Cardiology, Patras University Hospital, Patras, Greece.
authors: Ioanna
authors: I
authors: Xanthopoulou
authors: Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece.
authors: Spyridon
authors: S
authors: Deftereos
authors: Department of Cardiology, Larissa University Hospital, Larissa, Greece.
authors: George
authors: G
authors: Sitafidis
authors: Department of Clinical Therapeutics, "Alexandra" University Hospital, Athens, Greece.
authors: Ioannis
authors: I
authors: Kanakakis
authors: Department of Cardiology, Iraklion University Hospital, Iraklion, Greece.
authors: Michalis
authors: M
authors: Hamilos
authors: Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece.
authors: Christos
authors: C
authors: Angelidis
authors: Department of Cardiology, Iraklion University Hospital, Iraklion, Greece.
authors: Stylianos
authors: S
authors: Petousis
authors: Department of Cardiology, Alexandroupolis University Hospital, Alexandroupolis, Greece.
authors: Dimitrios
authors: D
authors: Stakos
authors: Department of Cardiology, Larissa University Hospital, Larissa, Greece.
authors: Haralambos
authors: H
authors: Parissis
authors: 1st University Department of Cardiology, Ippokration Hospital, Athens, Greece.
authors: Manolis
authors: M
authors: Vavouranakis
authors: Department of Cardiology, Patras University Hospital, Patras, Greece.
authors: Periklis
authors: P
authors: Davlouros
authors: Department of Cardiology, Ioannina University Hospital, Ioannina, Greece.
authors: John
authors: J
authors: Goudevenos
authors: 1st University Department of Cardiology, Ippokration Hospital, Athens, Greece.
authors: Christodoulos
authors: C
authors: Stefanadis
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000241:Adenosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D000077144:Clopidogrel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention; D010879:Piperazines / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians'; D000068799:Prasugrel Hydrochloride; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*; D012042:Registries; D013876:Thiophenes / Q000627:therapeutic use*; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010879:Piperazines; D058921:Purinergic P2Y Receptor Antagonists; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine