Author + information
- Kamal Shemisaa,b,
- Christopher Clarka,b,
- Kristin Alvareza,b,
- Houman Khalilia,b,
- Wanpen Vongpatanasina,b and
- Sandeep Dasa,b
Background: Dual anti-platelet therapy after placement of DES is indicated for one year to prevent stent thrombosis. The prevalence of premature ticagrelor discontinuation is not fully understood.
Methods: All patients receiving DES from January 2012 – June 2016 at Parkland Hospital were included; those with BMS, < 1 year follow-up or who were switched to clopidogrel were excluded. We collected 1 year fill data from a county subsidized care pharmacy system. Measurement of ticagrelor adherence was quantified as proportion days covered (PDC) and categorized as PDC >80%, PDC 40-79% and PDC <40%. Statin adherence was compared to ticagrelor to assess the relative impact of drug vs. patient-specific factors. Time to first failure to obtain a ticagrelor refill, with a 5-day grace period was measured.
Results: Our cohort (N=230) was 75% male, 47% HA, 20% CC, and 24% AA. Overall PDC at one year for ticagrelor (61% ± 32%) was modestly lower than statin (65% ± 34%, p<0.01). Stratified PDC was (PDC>80%, 43.9% vs. 42.8%), (PDC 40-79%, 23.0% vs. 30.0%) and (PDC<40%, 33.0% vs. 25.0%, p<0.001) (Figure 1). Both adherences correlated (Pearson r=0.73). Median time to failure was 90 days for ticagrelor.
Conclusions: In this urban safety net cohort, overall adherence to ticagrelor was poor. Despite commonly reported ticagrelor side effects like dyspnea, we found patient level effects for non-adherence were more influential than drug effects.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Antithrombotic Therapy in Ischemic Heart Disease
Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy
Presentation Number: 1252-311
- 2017 American College of Cardiology Foundation