title: Assessment of P2Y12 inhibitor usage and switching in acute coronary syndrome patients undergoing percutaneous coronary revascularization.
abstract: BACKGROUND
  Dual antiplatelet therapy is recommended for patients with acute coronary syndrome (ACS) that undergo percutaneous coronary intervention (PCI). However, the effect of switching P2Y12 inhibitors between the loading dose and therapy after discharge is not well described.
  
  
  METHODS
  This post-hoc analysis of a prospectively collected registry included 3219 consecutive ACS patients who underwent PCI. Patients were categorized into four groups: clopidogrel at load and discharge (C-C), loading dose of clopidogrel and discharged on prasugrel/ticagrelor (C-PT), loading dose of prasugrel/ticagrelor and discharged on clopidogrel (PT-C), and prasugrel/ticagrelor at load and discharge (PT-PT).
  
  
  RESULTS
  While 77.6% of patients received the C-C treatment regimen and 13.6% received the PT-PT strategy, the strategy of P2Y12 switching was fairly common with 6.2% in the PT-C group and 2.6% in the C-PT group. While C-C was the most common treatment regimen, PT-C and PT-PT were more commonly used in STEMI patients than in NSTEMI or unstable angina patients. A significantly lower unadjusted incidence of the composite outcome (death, MI, and repeat revascularization) was appreciated in both the PT-C (1.0%) and PT-PT (2.3%) groups than the C-C group (4.0%). Propensity-score matched analysis still showed significantly reduced risk (HR=0.22, 95% CI 0.05-0.93, p=0.04) in the PT-C group vs. a matched group of C-C controls.
  
  
  CONCLUSIONS
  The strategy of utilizing a newer P2Y12 inhibitor and then switching to clopidogrel in ACS patients following PCI is used with some frequency in routine clinical practice and further studies should evaluate the safety and efficacy of such a strategy.
authors: Department of Medicine, Allegheny General Hospital, Pittsburgh, PA, United States.
authors: Mrudula
authors: M
authors: Kudaravalli
authors: Heart and Vascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
authors: Andrew D
authors: AD
authors: Althouse
authors: Heart and Vascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
authors: Oscar C
authors: OC
authors: Marroquin
authors: Division of Cardiology, University of Pennsylvania, Philadelphia, PA, United States.
authors: Sameer J
authors: SJ
authors: Khandhar
authors: Heart and Vascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
authors: Michael S
authors: MS
authors: Sharbaugh
authors: Heart and Vascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
authors: Catalin
authors: C
authors: Toma
authors: Heart and Vascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
authors: A J
authors: AJ
authors: Conrad Smith
authors: Heart and Vascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
authors: John T
authors: JT
authors: Schindler
authors: Heart and Vascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
authors: Joon S
authors: JS
authors: Lee
authors: Heart and Vascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States; Division of Cardiology, Veterans Affairs Hospital, Pittsburgh, PA, United States. Electronic address: mulukutlasr@upmc.edu.
authors: Suresh R
authors: SR
authors: Mulukutla
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery; D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000359:Aftercare / Q000379:methods*; D000077144:Clopidogrel; D004305:Dose-Response Relationship, Drug; D057915:Drug Substitution / Q000379:methods; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D054539:Medication Therapy Management / Q000458:organization & administration*; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage / Q000009:adverse effects; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D012042:Registries; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine
keywords: Coronary disease; P2Y12 inhibitor; Percutaneous coronary intervention; Thienopyridine