title: Longer-term oral antiplatelet use in stable post-myocardial infarction patients: Insights from the long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease (TIGRIS) observational study.
abstract: OBJECTIVE
  To describe contemporary patient characteristics and treatment patterns, including antithrombotic management, of post-myocardial infarction (MI) stable coronary artery disease (CAD) patients at high atherothrombotic risk from different geographical regions.
  
  
  METHODS
  Patients ≥50years with prior MI 1-3years ago and ≥1 risk factor (age ≥65years, diabetes, 2nd prior MI >1yr ago, multivessel CAD, creatinine clearance 15-<60ml/min) were enrolled by 369 physicians (96% cardiologists) in 25 countries (2013-14) in the prospective TIGRIS study (NCT01866904).
  
  
  RESULTS
  9225 patients were enrolled (median 1.8years) post-MI: 52% with prior ST-elevation MI, median age 67years, 24% women, 67% Caucasian, 55% had ≥2 additional qualifying risk factors, 14% current smokers, 67% overweight/obese, 34% with blood pressure ≥140/90mmHg. 81% underwent percutaneous coronary intervention (PCI; 66% with drug-eluting stents) for the index MI. 75% of patients had been discharged on dual antiplatelet therapy (DAPT; acetylsalicylic acid [ASA]+ADP receptor inhibitor [ADPri]), mainly clopidogrel (75%). 63% had discontinued antiplatelet treatment (60% ADPri) around 1year, most commonly by physician recommendation (90%). At enrolment, 97% were taking an antithrombotic drug, most commonly ASA (88%), with 27% on DAPT (median duration 1.6years); continued DAPT >1year was highest (39%) in Asia-Pacific and lowest (12%) in Europe.
  
  
  CONCLUSIONS
  Despite guideline recommendations, 1 in 4 post-MI patients did not receive DAPT for ~1year. In contrast to guideline recommendations supporting newer ADPris, clopidogrel was mainly prescribed. Prior to recent RCT data supporting DAPT >1year post-MI/PCI, >1 in 4 patients have continued on DAPT, though with substantial international variability.
authors.affiliation: Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Canada. Electronic address: goodmans@smh.ca.
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Jose C
authors.initials: JC
authors.lastname: Nicolau
authors.affiliation: Oxon Epidemiology (UK), London, UK.
authors.forename: Gema
authors.initials: G
authors.lastname: Requena
authors.affiliation: Oxon Epidemiology (UK), London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Maguire
authors.affiliation: Division of Cardiology, University Heart Center Eppendorf, Hamburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.affiliation: Guangdong General Hospital, Provincial Key Laboratory of Coronary Disease, Guangzhou, China.
authors.forename: Ji Yan
authors.initials: JY
authors.lastname: Chen
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, USA.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Grieve
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Pocock
authors.affiliation: Assistance Publique-Hopitaux de Paris (APHP), UPMC-Paris 06 University, Paris, France.
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.affiliation: National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
authors.affiliation: Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Madrid, Spain.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Vega
authors.affiliation: Concord Hospital and University of Sydney, Sydney, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Brieger
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology; D023903:Coronary Restenosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007391:International Cooperation; D000069451:Long Term Adverse Effects / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000601:surgery*; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Antiplatelet therapy; Myocardial infarction