Department of Cardiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), C/ Maestro Alonso s/n, 03010, Alicante, Spain.
Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación (IMIB-Arrixaca), CIBER-CV, Murcia, Spain.
Clin Drug Investig. 2019 Mar;39(3):275-283. doi: 10.1007/s40261-018-0736-z.
Dual antiplatelet therapy is one of the main treatments in acute coronary syndrome (ACS). Switching antiplatelet agents may be necessary in some patients to improve efficacy or safety. The objective of this study was to determine the prevalence, predictors, and implications of clinical switching in patients during hospital admission and 1-year follow-up at discharge.
Observational, prospective, multicenter registry study in patients discharged following an admission for ACS and followed up for 1 year. We analyzed ischemic and bleeding events as well as treatment changes.
We recruited 1717 patients; in-hospital switching occurred in 425 (24.8%): 15.1% to clopidogrel and 84.9% to newer antiplatelet drugs (prasugrel or ticagrelor). Those switched to newer antiplatelets were younger, with lower scores on the GRACE and CRUSADE scales, admitted more frequently for ST-elevation myocardial infarction and underwent more invasive management and percutaneous revascularization. The clinical cardiologist was responsible for most in-hospital switching to newer antiplatelets (79.6%). The loading dose of the second antiplatelet did not affect incidence of bleeding events. Post-discharge switching was infrequent (2%) and depended mainly on clinical indications; only 30% was related to a new ACS.
In a contemporary registry with ACS, in-hospital switching of antiplatelet drugs was frequent. Those switched to newer antiplatelets were younger and admitted more frequently for ST-elevation myocardial infarction. Post-discharge switching was infrequent.
双联抗血小板治疗是急性冠状动脉综合征（ACS）的主要治疗方法之一。在某些患者中，可能需要更换抗血小板药物以提高疗效或安全性。本研究旨在确定住院期间和出院后 1 年随访期间患者临床换用抗血小板药物的发生率、预测因素及影响。
这是一项针对 ACS 出院患者进行的观察性、前瞻性、多中心登记研究，随访时间为 1 年。我们分析了缺血和出血事件以及治疗变化。
共纳入 1717 例患者；住院期间发生药物转换 425 例（24.8%）：15.1%换用氯吡格雷，84.9%换用新型抗血小板药物（普拉格雷或替格瑞洛）。换用新型抗血小板药物的患者年龄较小，GRACE 和 CRUSADE 评分较低，更频繁地因 ST 段抬高型心肌梗死入院，接受更积极的侵入性治疗和经皮血运重建。临床心内科医生负责大多数院内换用新型抗血小板药物（79.6%）。第二种抗血小板药物的负荷剂量不影响出血事件的发生率。出院后药物转换不常见（2%），主要取决于临床指征；仅 30%与新发 ACS 相关。
在当代 ACS 登记研究中，住院期间抗血小板药物的转换较为常见。换用新型抗血小板药物的患者年龄较小，更频繁地因 ST 段抬高型心肌梗死入院。出院后药物转换不常见。
