title: Occurrence, causes, and outcome after switching from ticagrelor to clopidogrel in a real-life scenario: data from a prospective registry.
abstract: In randomized clinical trials, ticagrelor has been substituted in roughly one-third of the patients during follow-up. To date, there are no studies addressing safety and modalities of switching from ticagrelor to clopidogrel. The aim of our study is to describe the occurrence, causes, and outcome of the switch from ticagrelor to clopidogrel in a real-life scenario. From June 2013 to March 2015, 586 patients were treated with ticagrelor in our centre. Overall, 101 (17%) patients were switched to clopidogrel through a standardized protocol, and they were followed-up for 12 months. Ischemic and bleeding events were prospectively recorded. The switch from ticagrelor to clopidogrel occurred mostly after discharge (69 ± 40 days), and the most frequent cause was the need of oral anticoagulation treatment, followed by bleeding events. Patients requiring ticagrelor discontinuation were older, more frequently female, with lower body mass index and creatinine clearance if compared to the "non-switched" group. In the 10 days after the switch, we did not observe ischemic adverse events. No definite/probable stent thrombosis was recorded. Before the switch, there was a significant higher occurrence of BARC bleedings in the "switched" group, particularly BARC 1 and 2. Our data confirm that the switch from ticagrelor to clopidogrel is common, and it occurs for several reasons. Our analysis did not demonstrate a significant increase in adverse cardiovascular events in the days following the switch from ticagrelor to clopidogrel, although larger studies are needed to validate our findings.
authors.affiliation: a Cardiovascular Institute , Azienda Ospedaliera Universitaria S.Anna , Ferrara , Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Biscaglia
authors.affiliation: a Cardiovascular Institute , Azienda Ospedaliera Universitaria S.Anna , Ferrara , Italy.|b Department of Morphology, Surgery and Experimental Medicine, LTTA Centre , Ferrara , Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Campo
authors.affiliation: a Cardiovascular Institute , Azienda Ospedaliera Universitaria S.Anna , Ferrara , Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Pavasini
authors.affiliation: a Cardiovascular Institute , Azienda Ospedaliera Universitaria S.Anna , Ferrara , Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Tebaldi
authors.affiliation: a Cardiovascular Institute , Azienda Ospedaliera Universitaria S.Anna , Ferrara , Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Tumscitz
authors.affiliation: a Cardiovascular Institute , Azienda Ospedaliera Universitaria S.Anna , Ferrara , Italy.|b Department of Morphology, Surgery and Experimental Medicine, LTTA Centre , Ferrara , Italy.|c Maria Cecilia Hospital , GVM Care & Research, E.S.: Health Science Foundation , Cotignola , Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D000241:Adenosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002423:Cause of Death; D000077144:Clopidogrel; D015897:Comorbidity; D057915:Drug Substitution / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012042:Registries; D012307:Risk Factors; D000077486:Ticagrelor; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine
keywords: Acute coronary syndrome; bleeding; clopidogrel; drug switching; ticagrelor