title: Treatment pattern of contemporary dual antiplatelet therapies after acute coronary syndrome: a Swedish nationwide population-based cohort study.
abstract: OBJECTIVE
  New dual antiplatelet therapies (DAPTs) have been introduced in clinical practice for patients with acute coronary syndrome (ACS). This nationwide study investigated DAPT patterns over time and patient characteristics associated with the various treatments in a population with ACS.
  
  
  METHODS
  This observational cohort study linked morbidity, mortality and medication data from Swedish national registries.
  
  
  RESULTS
  Overall, 91% (104 012 patients) of all patients admitted to the hospital with an ACS (2009-2013) were alive after discharge and included in this study. Compared with 2009, in 2013 patients investigated with angiography increased by 10%, patients revascularized with percutaneous coronary intervention (PCI) increased by 11% and patients prescribed DAPT increased by 8%. Mean DAPT duration increased from 225 to 298 days in patients investigated with angiography, and from 155 to 208 days in patients who were not investigated with angiography. Furthermore, in patients undergoing angiography a treatment switch from clopidogrel to ticagrelor was observed. DAPT with prasugrel was used to a low extent. Approximately 10% of patients initiated on prasugrel or ticagrelor switched to clopidogrel during the first year of treatment.
  
  
  CONCLUSIONS
  During the study more patients underwent angiography and PCI. There was an increase in the proportion of ACS patients receiving DAPT, as well as longer duration of DAPT in line with ESC guidelines. Among DAPT-treated patients, ticagrelor has emerged as the preferred P2Y12 antagonist in patients undergoing angiography, whereas clopidogrel tended to be prescribed to patients treated non-invasively.
authors.affiliation: a Sahlgrenska University Hospital , Gothenburg , Sweden ;
authors.forename: Oskar
authors.initials: O
authors.lastname: Angerås
authors.affiliation: b AstraZeneca, Södertälje , Sweden ;
authors.forename: Pål
authors.initials: P
authors.lastname: Hasvold
authors.affiliation: c Statisticon , Uppsala , Sweden ;
authors.forename: Marcus
authors.initials: M
authors.lastname: Thuresson
authors.affiliation: b AstraZeneca, Södertälje , Sweden ;
authors.forename: Anna
authors.initials: A
authors.lastname: Deleskog
authors.affiliation: d Department of Cardiology , Lund University, Skåne, University Hospital , Lund , Sweden.
authors.forename: Oscar
authors.initials: O
authors.lastname: ÖBraun
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000639:trends; D057915:Drug Substitution / Q000639:trends; D004359:Drug Therapy, Combination; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012042:Registries; D012189:Retrospective Studies; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Acute coronary syndrome; dual antiplatelet treatment; nationwide registry data