Clinical InvestigationInterventional CardiologyIn-hospital switching of oral P2Y12 inhibitor treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention: Prevalence, predictors and short-term outcome
Section snippets
Study protocol
GRAPE is a prospective, ongoing, observational, multicenter, cohort study focusing on contemporary antiplatelet use conducted in 8 Greek Hospitals with PCI facilities. GRAPE has been organized by the Cardiology Department of Patras University Hospital and is supported by the Hellenic Cardiological Society. The participating hospitals were selected on the basis of geographic distribution to cover the larger part of the Country. Consecutive, moderate to high risk ACS patients undergoing PCI who
Results
Demographic and clinical characteristics, clinical presentation and laboratory evaluation according to P2Y12 inhibitor switching status in 1794 registered patients are presented in Table I, Table II. Clopidogrel only, prasugrel only and ticagrelor only were administered in 664 (37%), 146 (8.1) and 343 (19.1%) patients, respectively, while switching to another P2Y12 inhibitor occurred in 636 (35.5%) patients. Among them, treatment was changed from clopidogrel to either ticagrelor or prasugrel in
Discussion
In a real-life experience with contemporary antiplatelet treatment in ACS patients undergoing PCI, in-hospital P2Y12 inhibitor switching occurred commonly, in more than 1/3 of treated patients. Switching to a novel agent was the main form of switching, while changing from a novel agent to clopidogrel occurred less often.
In GRAPE, P2Y12 inhibitor treatment was switched in-hospital in almost half of initially clopidogrel treated patients, an observed rate higher than other reports.13, 14 The more
Conclusions
Having 3 oral P2Y12 inhibitors to select for clinical use in addition to aspirin in patients with ACS undergoing PCI, in-hospital switching represents a common clinical practice. Clinical factors and regional practice differences seem to affect the choice of this strategy, while in-hospital switching to a novel P2Y12 inhibitor may be associated with an increased risk of bleeding up to one month post treatment initiation. Further randomized studies are mandatory to elucidate the safety and
Disclosures
Conflict of interest: Dr Alexopoulos reports receipt of speaker fees from AstraZeneca.
References (21)
- et al.
Increased platelet inhibition after switching from maintenance clopidogrel to prasugrel in patients with acute coronary syndromes: results of the SWAP (SWitching Anti Platelet) study
J Am Coll Cardiol
(2010) - et al.
Switching patients from clopidogrel to prasugrel in acute coronary syndrome. Effects of prasugrel loading dose on residual platelet reactivity
J Thromb Haemost.
(2012) - et al.
Pharmacodynamic effect of prasugrel 5 mg vs clopidogrel 150 mg in elderly patients with high on-clopidogrel platelet reactivity
Am Heart J
(2013) - et al.
Ticagrelor versus prasugrel in acute coronary syndrome patients with high on-clopidogrel platelet reactivity following percutaneous coronary intervention: a pharmacodynamic study
J Am Coll Cardiol
(2012) - et al.
Safety of reloading prasugrel in addition to clopidogrel loading in patients with acute coronary syndrome undergoing percutaneous coronary intervention
Am J Cardiol
(2013) - et al.
Switching acute coronary syndrome patients from prasugrel to clopidogrel
JACC Cardiovasc Interv
(2013) - et al.
Impact of “nuisance” bleeding on clopidogrel compliance in patients undergoing intracoronary drug-eluting stent implantation
Am J Cardiol
(2008) - et al.
Rate of nuisance bleedings and impact on compliance to prasugrel in acute coronary syndromes
Am J Cardiol
(2011) - et al.
Switching antiplatelet regimens: alternatives to clopidogrel in patients with acute coronary syndrome undergoing PCI: a review of the literature and practical considerations for the interventional cardiologist
Catheter Cardiovasc Interv
(2013) - et al.
Prevalence of contraindications and conditions for precaution for prasugrel administration in a real world acute coronary syndrome population
J Thromb Thrombolysis
(2011)
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