title: Real world insights on the initiation and treatment duration of oral antiplatelets in acute coronary syndromes: a retrospective cohort study.
abstract: This study is a real world, observational study evaluating the treatment persistence of oral antiplatelet (OAP) therapy during a one-year follow-up in patients after an acute coronary syndrome (ACS).
  
  
  
  Data on diagnosis, comorbidities, follow-up, OAP treatment, reasons, and decision maker for treatment discontinuation in patients who were discharged from a hospital in Belgium after an ACS between 1 July 2012 and 1 June 2013 were collected by cardiologists from 18 centres, up to 360 days from discharge. Out of the 671 patients surveyed, 295 patients were included in the persistence analysis. The remainder was excluded from the analysis due to the lack of precise information on OAP stopping date. The proportion of patients still using OAPs after 90, 180, 270, and 360 days was 92, 89, 83, and 73%, respectively. OAP persistence was higher for patients treated with prasugrel or ticagrelor. At 360 days, 79% of patients with a ST-segment elevation myocardial infarction (STEMI) and 66% of patients with a non-STEMI were still adhering to the prescribed course of treatment. Among the 79 patients with early treatment discontinuation, the mean treatment duration was 197.0 ± 125.18 days. The main decision taker in premature treatment cessation was the cardiologist (31% of cases), while the most frequently cited reasons included surgery (25%) and perceived high bleeding risk (19%).
  
  
  
  Treatment persistence with OAPs after ACS in Belgium is high throughout the recommended period. Discontinuation was observed more often in patients treated with clopidogrel and was mainly initiated by the cardiologist.
authors.affiliation: Department of Cardiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Claeys
authors.affiliation: Institut de Recherche Expérimentale et Clinique, Pôle de Recherche Cardiovasculaire, Université Catholique de Louvain, Prom. de l'Alma, 1200 Woluwe St-Lambert, Brussels, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Beauloye
authors.affiliation: Service de Cardiologie, Centre Hospitalier Régional de la Citadelle, Boulevard du Douzième de Ligne 1, 4000, Liège, Belgium.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Pourbaix
authors.affiliation: Department of Cardiovascular Sciences, University Hospitals Leuven, O&N I Herestraat 49, 3000, Leuven, Belgium.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Sinnaeve
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D000284:Administration, Oral; D000368:Aged; D001530:Belgium; D000072096:Cardiologists; D000077144:Clopidogrel / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D010818:Practice Patterns, Physicians'; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000077486:Ticagrelor / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor
keywords: Acute coronary syndrome ; Clopidogrel; Oral antiplatelet therapy ; Prasugrel ; Ticagrelor ; Treatment persistence 