Frequency, Reasons, and Impact of Premature Ticagrelor Discontinuation in Patients Undergoing Coronary Revascularization in Routine Clinical Practice: Results From the Bern Percutaneous Coronary Intervention Registry

Circulation. Cardiovascular Interventions
Thomas ZanchinLorenz Räber

Abstract

Although ticagrelor has improved clinical outcomes among patients with acute coronary syndrome compared with clopidogrel, adherence to this new antiplatelet agent in real-world practice has not been fully investigated. Between November 2011 and June 2014, 1278 of 4831 consecutive patients (26.5%) undergoing percutaneous coronary intervention at a tertiary care center were treated with ticagrelor. Premature ticagrelor cessation was categorized into (1) change, when ticagrelor was replaced by prasugrel; (2) de-escalation, when ticagrelor was replaced by clopidogrel; and (3) premature discontinuation, when ticagrelor was discontinued without P2Y12 inhibitor replacement. Of 1278 patients treated with ticagrelor, premature treatment cessation occurred in 212 patients (17%). De-escalation to clopidogrel was the most frequent scenario (57%; n=120), followed by premature discontinuation (28%; n=60) and change to prasugrel (15%; n=32). Reasons for ticagrelor cessation included adverse effects (49%), initiation of oral anticoagulation (19%), and unspecified general practitioner preference (10%). Most frequent adverse effects leading to premature ticagrelor cessation were bleeding (41%), dyspnea (29%), and gastrointestinal symptoms (18%)....Continue Reading

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Citations

Jul 16, 2020·European Heart Journal. Cardiovascular Pharmacotherapy·Alberto GiannoniClaudio Passino
Nov 27, 2019·European Journal of Preventive Cardiology·Bianca RoccaFrancesco Zaccardi
Apr 2, 2020·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Kangho SuhKelley R Branch
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Feb 7, 2019·Journal of Cardiovascular Pharmacology and Therapeutics·Dimitrios AlexopoulosCharalambos Varlamos
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Mar 12, 2021·Expert Review of Cardiovascular Therapy·Felix VollSalvatore Cassese
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Aug 31, 2021·European Heart Journal. Cardiovascular Pharmacotherapy·Anne H TavenierGeorge Dangas
Mar 7, 2020·American Journal of Therapeutics·Mohammed AliOmar E Ali
Dec 16, 2021·Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation·F ArslanUNKNOWN Coronary Artery Aneurysm Registry (CAAR) investigators

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