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DI-028 Novel oral antiplatelet agents in acute coronary syndrome. Prescription profile in a tertiary hospital
  1. MA Ocaña Gomez1,
  2. EG Fernández López2,
  3. E Tevar Alfonso2,
  4. I Plasencia Garcia2,
  5. T Betancor Garcia2,
  6. M Suarez Gonzalez2,
  7. R Jurado Lopez2,
  8. C Fraile Clemente1,
  9. J Merino Alonso1
  1. 1Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
  2. 2Hospital Nuestra Señora de Candelaria, Spain

Abstract

Background Current clinical practice guidelines for acute coronary syndrome recommend that patients should receive dual antiplatelet treatment with acetylsalicylic acid and an ADP receptor inhibitor for 12 months.

Today, two novel P2Y12 receptor inhibitors, prasugrel and ticagrelor, have been developed that offer more effective and faster platelet inhibition than clopidogrel. Current guidelines recommend that these compounds should be used in preference to clopidogrel in a wide range of patients.

Purpose To assess the prescription profile of novel oral antiplatelet agents for acute coronary syndrome in the cardiology department of a tertiary hospital. Correlation with present guidelines of the European Society of Cardiology.

Material and methods Retrospective descriptive study over a 5 year period (January 2010 to April 2015).

The percentage of patients treated with clopidogrel, prasugrel or ticagrelor was calculated with respect to the total number of patients treated with any P2Y12 receptor inhibitor.

Results Prescription profile has been changing since the new antiplatelet agents were authorised (prasugrel in 2009, ticagrelor in 2011).

Clopidogrel: 96% in 2011, 94% in 2012, 96% in 2013, 80% in 2014 and 71% in 2015.

Prasugrel: 4% in 2011, 6% in 2012, 1% in 2013 and 5% in 2014–2015.

Ticagrelor: 3% in 2013, 15% in 2014 and 24% in 2015.

  • A progressive increase in ticagrelor prescription to the detriment of clopidogrel was observed.

  • Prasugrel prescription is low and constant.

  • Clopidogrel is the most prescribed antiplatelet in this unit although guidelines recommend its use only in patients who cannot receive ticagrelor or prasugrel or who require oral anticoagulation (IB), and patients who receive fibrinolytic therapy.

Conclusion

  • Paradoxically new oral antiplatelet agents are used infrequently.

  • An increase in ticagrelor prescription is expected as it is recommended as the first option for all patients at moderate to high risk of ischaemic events regardless of the initial treatment strategy and including those pretreated with clopidogrel (IB).

  • Prasugrel has been shown to have greater clinical benefits than clopidogrel in patients who have undergone percutaneous coronary interventions (IB) but several restrictions limit it use compared with ticagrelor.

  • The development of standard clinical protocols would help improve the quality of care.

References and/or Acknowledgement 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST segment elevation.

ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST segment elevation.

No conflict of interest.

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