Author + information
- M. Chadi Alraies1,
- Homam Moussa Pacha2,
- Kyle Buchanan3,
- Toby Rogers1,
- Fahed Darmoch4,
- Edward Koifman1,
- Arie Steinvil5,
- Rebecca Torguson3,
- Linzhi Xu1,
- Itsik Ben-Dor6,
- Augusto Pichard3,
- Lowell Satler3 and
- Ron Waksman6
- 1MedStar Washington Hospital Center, Washington, District of Columbia, United States
- 2Medstar Washingtion Hospital Center, Silver Spring, Maryland, United States
- 3Washington Hospital Center, Washington, District of Columbia, United States
- 4Case Western Reserve University/ St Vincent medical center, Cleveland, Ohio, United States
- 5Medstar Washington Hospital center, Washington DC, USA, Washington, District of Columbia, United States
- 6Medstar Washington Hospital Center, Washington, District of Columbia, United States
While randomized clinical trials have compared clopidogrel with higher potency adenosine diphosphate (ADP) receptor inhibitors among patients with acute coronary syndrome (ACS), little is known about the frequency, effectiveness and safety of switching between ADP receptor inhibitors in routine clinical practice.
We studied 2,548 ACS patients treated with percutaneous coronary intervention (PCI) and received drug-eluting stent (DES) from 2007 until 2017. Primary combined endpoint was major adverse cardiac events (MACE) in the form of target lesion revascularization, myocardial infarction and mortality.
Among 1,765 ACS patients treated initially with clopidogrel, 106 (6%) were switched to ticagrelor at discharge. Among 783 patients treated initially with ticagrelor, 113 (14%) were switched to clopidogrel at discharge. Switching to ticagrelor was not associated with increased bleeding when compared with continuation of clopidogrel. Similarly, switching to clopidogrel was not associated with increased 1-year MACE rate (6.7% in clopidogrel-ticagrelor group, 7 % in ticagrelor-clopidogrel group (p = 0.13).
In-hospital ADP receptor inhibitor switching does not appear to be significantly associated with increased hazard of MACE or bleeding.
CORONARY: Acute Coronary Syndromes