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Southern Saskatchewan Ticagrelor Registry experience.

Payam Dehghani1, Varun Chopra1, Ali Bell2

  • 1Prairie Vascular Research Network, University of Saskatchewan, Regina, SK, Canada.

Patient Preference and Adherence
|October 25, 2014
PubMed
Summary

Ticagrelor use in acute coronary syndrome shows a third of patients receive off-label indications, and a fifth stop treatment early. Premature ticagrelor discontinuation is linked to worse outcomes, including major bleeding and cardiovascular events.

Keywords:
acute coronary syndromeadherenceantiplateletscomplianceregistryticagrelor

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Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Research

Background:

  • Ticagrelor is increasingly used for acute coronary syndrome (ACS).
  • Understanding real-world patient and physician behavior regarding ticagrelor use is crucial.
  • Key areas of interest include appropriate prescribing, medication adherence, and clinical event rates.

Purpose of the Study:

  • To evaluate on- and off-label use of ticagrelor in ACS patients.
  • To identify patient characteristics associated with premature ticagrelor discontinuation.
  • To describe factors contributing to inappropriate cessation of ticagrelor therapy.

Main Methods:

  • Prospective, observational, multicenter cohort study (Southern Saskatchewan Ticagrelor Registry).
  • Inclusion of consecutive patients initiated on ticagrelor.
  • Analysis of patient demographics, indications, adherence, and clinical outcomes.

Main Results:

  • 227 patients initiated on ticagrelor (mean age 62.2 years, 66% male).
  • 32.4% of patients received off-label indications.
  • 20.7% prematurely stopped ticagrelor, associated with older age, female sex, non-white ethnicity, shock, and dyspnea.
  • Premature discontinuation was linked to nonadherence (18 patients) and physician advice (8 patients).
  • Composite endpoint (vascular death, MI, stroke) occurred in 8.8%, higher in older patients, those with shock, and those stopping ticagrelor early.

Conclusions:

  • A significant proportion of ticagrelor use in ACS is off-label (one-third).
  • Premature discontinuation affects one-fifth of patients and is an independent predictor of adverse events.
  • Early cessation of ticagrelor is associated with increased risk of major bleeding and composite cardiovascular events.