title: Switching of adenosine diphosphate receptor inhibitor after hospital discharge among myocardial infarction patients: Insights from the Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome (TRANSLATE-ACS) observational study.
abstract: The reasons for postdischarge adenosine diphosphate receptor inhibitor (ADPri) switching among patients with myocardial infarction (MI) are unclear. We sought to describe the incidence and patterns of postdischarge ADPri switching among patients with acute MI treated with percutaneous coronary intervention.
  
  
  METHODS
  We used TRANSLATE-ACS (2010-2012) data to assess postdischarge ADPri switching among 8,672 MI patients discharged after percutaneous coronary intervention who remained on ADPri therapy 1 year post-MI. We examined patient-reported reasons for switching, GUSTO moderate or severe bleeding, major adverse cardiovascular events (MACEs), and definite stent thrombosis events around the time of the switch.
  
  
  RESULTS
  Among patients still on ADPri therapy 1 year post-MI, 663 (7.6%) switched ADPri during that year. Switching occurred at a median of 50 days postdischarge and most frequently in patients discharged on ticagrelor (64/226; 28.3%), followed by prasugrel (383/2,489; 15.4%) and clopidogrel (216/5,957; 3.6%) (P < .001). Among patients discharged on prasugrel, 97.3% of switches were to clopidogrel and 87.5% of ticagrelor switches were to clopidogrel; both of these groups most often cited cost as a reason for switching (43.6% and 39.1%, respectively), whereas 60.7% who switched from clopidogrel cited physician decision as a reason. In the 7 days preceding the switch from clopidogrel, 40 (18.5%) had a MACE and 12 (5.6%) had a definite stent thrombosis event, whereas that from prasugrel or ticagrelor, a GUSTO moderate or severe bleeding event occurred in 1 (0.3%) and 0 patients, respectively.
  
  
  CONCLUSIONS
  Postdischarge ADPri switching occurred infrequently within the first year post-MI and uncommonly was associated with MACEs or bleeding events.
authors.affiliation: Eli Lilly & Company, Indianapolis, IN.
authors.forename: Marjorie E
authors.initials: ME
authors.lastname: Zettler
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: McCoy
authors.affiliation: Eli Lilly & Company, Indianapolis, IN.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Effron
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Henry
authors.affiliation: Daiichi Sankyo, Inc., Parsippany, NJ.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Baker
authors.affiliation: University of Colorado School of Medicine, Aurora, CO.
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, MO.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: Duke Clinical Research Institute, Durham, NC. Electronic address: tracy.wang@dm.duke.edu.
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
mesh_terms: D000241:Adenosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000244:Adenosine Diphosphate; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D000077144:Clopidogrel; D057915:Drug Substitution / Q000706:statistics & numerical data*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010351:Patient Discharge; D057240:Patient Preference; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D000068799:Prasugrel Hydrochloride / Q000627:therapeutic use; D058915:Purinergic P1 Receptor Antagonists / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D058915:Purinergic P1 Receptor Antagonists; D000244:Adenosine Diphosphate; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine