Klinikum Ludwigshafen, Bremserstrasse 79, Ludwigshafen/Rhein, Germany.
Institut für Herzinfarktforschung Ludwigshafen, Bremserstrasse 79, Ludwigshafen/Rhein, Germany.
Eur Heart J Cardiovasc Pharmacother. 2018 Oct 1;4(4):205-210. doi: 10.1093/ehjcvp/pvy018.
Little is known about the adherence to dual antiplatelet therapy with ticagrelor and reasons for discontinuation in real life. Therefore, we evaluated the 12-month course of patients with acute coronary syndromes (ACS) treated with percutaneous coronary intervention (PCI) and ticagrelor during the acute phase.
A total of 614 patients included into the prospective ALKK-PCI Registry between 2014 and 2015 surviving for at least 12 months after discharge provided informations about duration of ticagrelor therapy. In total, 133 patients (21.7%) discontinued ticagrelor prematurely: nine patients before discharge and 124 (20.2%) at a mean 131 days after PCI. Independent baseline predictors for early discontinuation were age >75 years, atrial fibrillation, and prior stroke. Side effects such as dypnoea or bradycardias and bleeding leading to a premature discontinuation of ticagrelor were reported in less than 3% and less than 2% of the total patient population, respectively. In 50% of patients, there was no replacement with another platelet inhibitor after early discontinuation of ticagrelor, while in 28.2% it was replaced by clopidogrel. Bleeding events were observed more often (10.4% vs. 2.7%, P < 0.001) and coronary artery bypass grafting (CABG) (5.3% vs. 0, 4%, P < 0.001) was performed more often in patients with early discontinuation.
In this real-life experience of ticagrelor in patients with ACS 22% of patients discontinued ticagrelor early. Side effects were the cause for discontinuation in only 3%, while age >75 years, prior stroke, atrial fibrillation, CABG, and bleeding during follow-up were associated with premature discontinuation.
对于接受替格瑞洛双联抗血小板治疗的患者，真实世界中人们对其用药依从性以及停药原因知之甚少。因此，我们评估了在急性冠状动脉综合征（ACS）患者接受经皮冠状动脉介入治疗（PCI）和替格瑞洛治疗的急性期后，12 个月的病程。
在 2014 年至 2015 年期间，共有 614 例患者前瞻性纳入 ALKK-PCI 注册研究，在出院后至少 12 个月时提供了关于替格瑞洛治疗时间的信息。共有 133 例患者（21.7%）过早停用替格瑞洛：9 例在出院前，124 例（20.2%）在 PCI 后平均 131 天。早期停药的独立基线预测因素为年龄>75 岁、心房颤动和既往卒中。因呼吸困难或心动过缓以及导致提前停用替格瑞洛的出血而报告的副作用在总患者人群中分别占不到 3%和不到 2%。在 50%的患者中，替格瑞洛早期停药后没有用另一种血小板抑制剂替代，而在 28.2%的患者中，用氯吡格雷替代。在早期停药的患者中，出血事件更常见（10.4%比 2.7%，P<0.001），且接受冠状动脉旁路移植术（CABG）的患者更多（5.3%比 0，4%，P<0.001）。
在 ACS 患者接受替格瑞洛的真实世界经验中，22%的患者早期停用替格瑞洛。仅有 3%的患者因副作用停药，而年龄>75 岁、既往卒中、心房颤动、CABG 和随访期间出血与过早停药相关。
