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The underutilisation of dual antiplatelet therapy in acute coronary syndrome

Malcolm Anastasius1, Jerrett K Lau1, Karice Hyun2

  • 1Department of Cardiology, Concord Repatriation General Hospital, University of Sydney, Sydney, Australia.

International Journal of Cardiology
|May 7, 2017
PubMed

Insights

Dual antiplatelet therapy (DAPT) is underutilized in acute coronary syndrome (ACS) despite guidelines. This study identified patient subgroups not receiving DAPT, highlighting a treatment gap needing intervention.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Dual antiplatelet therapy (DAPT) is recommended for acute coronary syndrome (ACS) but is underutilized.
  • Identifying predictors of DAPT non-prescription is crucial for improving patient outcomes.

Purpose of the Study:

  • To determine independent predictors of DAPT non-prescription in ACS patients.
  • To describe patterns of DAPT prescription over time in ACS management.

Main Methods:

  • Analysis of 8939 ACS patients from 41 Australian hospitals (2009-2016).
  • Stratification by discharge antiplatelet therapy: DAPT, single antiplatelet therapy (SAPT), or no antiplatelet therapy.
  • Multivariable logistic regression used to identify predictors of DAPT non-prescription.

Main Results:

  • 70.4% of ACS patients received DAPT at discharge; 24.1% received SAPT, and 5.5% received no antiplatelet therapy.
  • In-hospital CABG, warfarin use, major bleeding, unstable angina, NSTEMI, atrial arrhythmia, hypertension, and high GRACE risk were predictors of DAPT non-prescription.
  • DAPT prescription increased from 2013-2016, with a shift towards ticagrelor over clopidogrel, but no overall change in DAPT frequency across the study period.

Conclusions:

  • High-risk ACS subgroups are identified as not receiving optimal DAPT.
  • Strategies are needed to address the treatment gap in antiplatelet management for ACS patients.
Abstract

Keywords:
Acute coronary syndromeDual antiplatelet therapy

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