Author + information
- Alfredo Redondo Dieguez,
- Ana Belen Cid Alvarez,
- Ramiro Trillo Nouche,
- Carlos Galvao,
- Diego Lopez Otero,
- Raymundo Ocaranza,
- Monica Fernandez,
- Rocio Gonzalez Ferreiro and
- JR Gonzalez-Juanatey
Prasugrel and Ticagrelor have an IA indication in Acute Myocardial Infarction in patients presenting with ST-segment elevation (STEMI) ESC clinical guidelines. First Prasugrel and then Ticagrelor became recently funded our National Health System.
Our aim was to describe how the implementation of these novel antiplatelets therapies was in a real world cohort of patients discharged alive after an STEMI who underwent to primary percutaneous coronary intervention.
We included 369 consecutive STEMI patients referred for primary percutaneous coronary intervention (PCI) in our center, since April 2014 (when ticagrelor became avaliable) until December 2015, discharged alive with the primary diagnosis of STEMI.
142 patients were discharged with Clopidogrel (38,5%), 150 with ticagrelor (40,7%) and 77 with prasugrel (20,9%). Patients discharged with clopidogrel were older, with lower weight, and with lower estimated glomerular glomerular filtration rate (eGFR) compared to the other groups. Also GRACE and the CRUSADE risks scores were significantly higher in patients discharged with clopidogrel. It's remarkable, that patients who recieved new oral antiplatelets at discharge were more usually smokers and in patients treated with prasugrel diabetes mellitus (DM) was more prevalent.
We analyzed in each subgroup if the prescription of drugs was done acording to current guidelines, therefore we consider that ticagrelor or prasugrel were mandatory if no contraindication. Contraindications were: taking oral anticoagulation, CRUSADE >50, major bleeding during hospitalization, GFR < 15 mL/min/1.73 m2, Hb < 10 g/dL and taking oral anticoagulation at discharge; for prasugrel history of stroke, weigh < 60 Kg and age >= 75 were also considered contraindications.
Using this criteria up to 8,8% (20 of 227) of patients discharged with novel antiplatelets had at least one contraindication. 18,2% (14 of 77) of patients on prasugrel and a 4,0% (6 of150) of patients on ticagrelor had one or more contraindications.
In the total cohort 83,7% (309 of 369) of the population had no contraindication and could had been discharged with novel oral antiplatelets. 64,2% (95 of 142) of patients discharged with clopidogrel could had benefit of new antiplatelets.
In our registry most of the patients discharged alive after a STEMI who undego primary PCI were treated with new oral antiplatelets. Clinical criteria for prescription should improve, 8,8% of patients with new oral antiplatelets had contraindications and in the other hand 64,2% of patients dicharged with clopidogrel could have received new antiplatelets.