title: Patterns of Antiplatelet Therapy in Patients Who Have Experienced an Acute Coronary Event: A Descriptive Study in UK Primary Care.
abstract: BACKGROUND
  Antiplatelet (AP) therapy is well established for the secondary prevention of acute coronary events. However, patients may discontinue treatment, often owing to gastrointestinal (GI) complications, leaving them at elevated risk of recurrent cardiovascular events.
  
  
  OBJECTIVE
  This descriptive retrospective study assessed trends in prescription of AP agents and coprescription of gastroprotective therapy, after an acute coronary event. Discontinuation of AP therapy within 2 years of an event and factors predicting discontinuation were investigated.
  
  
  METHODS
  The study was conducted in a UK primary care setting from 2000 to 2008; a total of 27, 351 patients aged 50 to 84 years were included in the analysis. Main outcome measures were exposures to low-dose acetylsalicylic acid (ASA), clopidogrel, and proton pump inhibitors (PPIs).
  
  
  RESULTS
  At 90 days after an acute coronary event, 85.9% of patients had been prescribed some form of AP therapy and 33.6% of patients who were issued at least 1 ASA prescription in this period were also issued a PPI prescription. The use of dual antiplatelet therapy (DAT) 90 days after an event increased from 2% in 2000 to over 50% in 2008. An estimated 15.1% of patients on ASA monotherapy and 37.5% on DAT discontinued treatment within 1 year. A bleeding event during follow-up, including upper GI bleeding or hemorrhagic stroke, was the strongest predictor of discontinuation.
  
  
  CONCLUSIONS
  Although most patients were prescribed AP therapy in the 90 days following an acute coronary event, a substantial proportion discontinued DAT or ASA monotherapy within 1 year. It is essential that physicians consider strategies to reduce the risk of discontinuation of AP therapy.
authors.affiliation: Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain Andalusian Bioinformatics Research Centre (CAEBi), Seville, Spain.
authors.forename: María E
authors.initials: ME
authors.lastname: Sáez
authors.affiliation: Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain Andalusian Bioinformatics Research Centre (CAEBi), Seville, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: González-Pérez
authors.affiliation: AstraZeneca R&D, Mölndal, Sweden.
authors.forename: Saga
authors.initials: S
authors.lastname: Johansson
authors.affiliation: AstraZeneca R&D, Mölndal, Sweden.
authors.forename: Péter
authors.initials: P
authors.lastname: Nagy
authors.affiliation: Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain lagarcia@ceife.es.
authors.forename: Luis A García
authors.initials: LA
authors.lastname: Rodríguez
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D000077144:Clopidogrel; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D006470:Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D011320:Primary Health Care / Q000379:methods; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D006113:United Kingdom
chemical_list: D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: acetylsalicylic acid; acute coronary syndrome; antiplatelet agents; clopidogrel; proton pump inhibitors