Trends in prescribing patterns of ticagrelor, prasugrel and clopidogrel following percutaneous coronary intervention for acute coronary syndromes.

Abstract

Background: Antiplatelet therapy is paramount in the prevention of cardiovascular events following acute coronary syndromes (ACS), particularly following percutaneous coronary intervention (PCI). We aimed to identify trends and factors impacting the prescription of newer, more potent antiplatelet agents following PCI. Methods: We analysed data from 6,705 patients who underwent PCI for ACS in the Melbourne Interventional Group registry (2013-2017). Patients were grouped according to the second antiplatelet agent prescribed on discharge. Results: Patients prescribed ticagrelor and prasugrel on discharge were more likely to be male, younger, and have less co-morbidities, including diabetes, previous PCI and bypass surgery, cerebrovascular disease, chronic renal impairment and moderate-severe left ventricular dysfunction (all p<0.01). Patients who presented with STEMI and who received a drug-eluting stent were more likely to receive ticagrelor or prasugrel on discharge (p<0.01). Clopidogrel was more likely to be prescribed in patients on oral anticoagulants and in those who had major in-hospital bleeding (p<0.01). Patients discharged on clopidogrel had higher rates of revascularisation, major bleeding, stroke and MACCE at 30 days (p<0.01). The proportion of newer antiplatelets, particularly ticagrelor, prescribed following PCI for ACS has increased over time (figure). Among a separate cohort of patients undergoing PCI for stable coronary disease (n=3,005), ticagrelor was prescribed in 21.3% and prasugrel in 5.1%. Conclusion: In a large contemporary cohort, Australian prescribing patterns reflect evolving guidelines and current international practice, though there is a trend towards the use of clopidogrel in more comorbid populations. A quarter of patients with stable coronary disease are prescribed ticagrelor or prasugrel.