title: Extended dual antiplatelet therapy after acute coronary syndrome in Spain: Results from the EPICOR study.
abstract: Real-world, country-specific studies of dual antiplatelet therapy (DAPT) duration among survivors of acute coronary syndrome (ACS) are important for improving long-term prognosis.
  
  
  
  To investigate DAPT duration after hospital discharge for ACS in Spain.
  
  
  
  Data from patients enrolled in the Spanish cohort of the EPICOR (long-tErm follow-up of antithrombotic management Patterns In acute CORonary syndrome patients) study (NCT01171404) were analyzed for changes to antithrombotic medication up to 2 years postdischarge according to index event diagnosis and patient characteristics. Deaths, coronary events, and bleeding events were analyzed over the same period. Overall, a high proportion of patients remained on DAPT at 2 years (53.1%). Among patients who experienced any on-treatment bleeding event, almost two-thirds remained on DAPT at the end of follow-up. Patients >65 years, diabetic, or those that were medically managed were more likely to continue with DAPT until 2 years following discharge. At 2 years, the incidence of bleeding events requiring hospitalization was low compared with the incidence of coronary events (1.4% vs 6.6%). There was a numerical reduction in coronary events, but no increase in bleeding events, with DAPT continuation compared with single antiplatelet therapy.
  
  
  
  More than half of patients in this unselected cohort study remained on DAPT at 2 years following discharge for ACS. Continuation with DAPT was greater among patients with additional cardiovascular risk factors, which suggests that treating physicians in Spain prioritizes ischemic risk reduction over bleeding risk in patients with ACS, according to patient's risk profile.
authors.affiliation: Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII, IISPV, Universidad Rovira Virgili, Tarragona, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Bardají
authors.affiliation: AstraZeneca, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Leal
authors.affiliation: Servicio de Cardiología, Hospital General Universitario, Alicante, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Arrarte
authors.affiliation: Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Garcia-Moll
authors.affiliation: Department of Cardiology, Clinical Hospital San Carlos, Health Research Institute, San Carlos, Madrid, Spain.|Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Pérez de Isla
authors.affiliation: Universidad Complutense de Madrid, Madrid, Spain.|Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.|Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000284:Administration, Oral; D000368:Aged; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors
keywords: ADP Receptor antagonists; Acute coronary syndrome; Antiplatelet agents; Coronary artery disease; Myocardial infarction; Secondary prevention