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[Contemporary use of ticagrelor in patients with acute coronary syndrome after discharge]

J Liu1, H B Yan, L Song

  • 1State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China.

Zhonghua Yi Xue Za Zhi
|April 21, 2017
PubMed

Insights

Many acute coronary syndrome patients stop ticagrelor post-discharge due to social factors like insurance and infrequent follow-ups. Stopping ticagrelor did not significantly increase ischemic events.

Area of Science:

  • Cardiology
  • Pharmacoeconomics
  • Public Health

Background:

  • Acute coronary syndrome (ACS) management often involves dual antiplatelet therapy.
  • Ticagrelor is a P2Y12 inhibitor frequently prescribed post-ACS.
  • Understanding real-world adherence and discontinuation patterns is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To determine the rate of ticagrelor use among discharged ACS patients.
  • To identify factors influencing premature discontinuation or switching from ticagrelor.
  • To assess the impact of discontinuation on ischemic events.

Main Methods:

  • Retrospective analysis of 404 ACS patients discharged on ticagrelor.
  • Data collection via electronic medical records and telephone interviews.
  • Statistical analysis including univariate and multivariate logistic regression.

Main Results:

  • 39.1% discontinued ticagrelor and 29.5% switched to clopidogrel within 12 months.
  • Key reasons for discontinuation: unavailability (34.8%), cost (17.7%), and bleeding (18.4%).
  • Medical insurance payment and infrequent outpatient follow-up predicted premature discontinuation.

Conclusions:

  • Social determinants, particularly medical insurance and follow-up frequency, significantly impact ticagrelor adherence in ACS patients.
  • Premature ticagrelor discontinuation did not correlate with increased ischemic events.
  • Interventions addressing socioeconomic barriers may improve long-term ticagrelor persistence.

Keywords:
Acute coronary syndromeMedication AdherenceTicagrelor

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