Contemporary Prescription Patterns of Adenosine Diphosphate Receptor Inhibitors in Acute Coronary Syndrome
Insights
Clopidogrel remains the most prescribed antiplatelet medication for acute coronary syndrome, especially in elderly patients with multiple health issues. Treatment adjustments were common due to efficacy or safety concerns.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Acute coronary syndrome (ACS) management involves antiplatelet therapy.
- Adenosine diphosphate (ADP) receptor inhibitors are crucial in ACS treatment.
- Contemporary prescribing patterns for ADP inhibitors in ACS require evaluation.
Purpose of the Study:
- To assess the current utilization of ADP receptor inhibitors in ACS patients.
- To analyze prescribing trends of ticagrelor, prasugrel, and clopidogrel in a quaternary academic medical center.
Main Methods:
- Retrospective observational study design.
- Analysis of health records for ACS patients from January 2014 to December 2014.
- Comparison of treatment patterns for ticagrelor, prasugrel, and clopidogrel.
Main Results:
- Clopidogrel was the most prescribed ADP inhibitor (52%), followed by ticagrelor (26%) and prasugrel (22%).
- Patients on clopidogrel were more likely to be older, female, underweight, and have more comorbidities.
- Switching of therapy occurred in 21% of clopidogrel users and 17% of ticagrelor/prasugrel users due to efficacy, safety, or cost concerns.
Conclusions:
- Clopidogrel remains the predominant antiplatelet agent in ACS, particularly in elderly and comorbid patients.
- Suboptimal prescribing outside FDA guidelines was observed for all agents.
- Treatment adjustments highlight ongoing challenges in optimizing antiplatelet therapy for ACS.
Purpose:
To assess the contemporary use of adenosine diphosphate (ADP) receptor inhibitors in acute coronary syndrome at a large, quaternary academic medical center.
Methods:
A retrospective observational study was conducted using health records to compare patients who were treated with ticagrelor (Brilinta, AstraZeneca), prasugrel, or clopidogrel for a primary diagnosis of new-onset acute coronary syndrome between January 2014 and December 2014.
Results:
A total of 275 patients were identified. Clopidogrel was the most commonly prescribed ADP receptor antagonist (52%), followed by ticagrelor (26%) and prasugrel (22%). Patients who were prescribed clopidogrel were more likely female (P < 0.01), 75 years of age or older (P < 0.01), and 60 kg or less in weight (P = 0.02), and they had more comorbidities. Of the patients on clopidogrel prior to admission, 21% were switched to prasugrel or ticagrelor for inadequate platelet inhibition, restenosis, or new stent placement. Of the patients on ticagrelor or prasugrel prior to admission, 17% were switched to clopidogrel for concerns about bleeding or cost. Clopidogrel was prescribed 13% of the time, prasugrel 13% of the time, and ticagrelor 4% of the time (P = 0.13) outside the recommended use per Food and Drug Administration-approved prescribing information based on relative or absolute contraindications.
Conclusion:
Clopidogrel continues to be the most commonly prescribed antiplatelet agent, particularly in older patients with more comorbidities.
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