Prescription Patterns of Clopidogrel, Prasugrel, and Ticagrelor After Percutaneous Coronary Intervention With Stent Implantation (from the NCDR PINNACLE Registry).

Abstract

The use of prasugrel and ticagrelor as part of dual antiplatelet therapy is increasing in patients after percutaneous coronary intervention (PCI). Accordingly, we aimed to evaluate their prescription patterns in the National Cardiovascular Data Registry (NCDR) Practice Innovation and Clinical Excellence (PINNACLE) registry. We analyzed patients enrolled in NCDR PINNACLE registry from January 2013 to March 2015 who underwent PCI with drug-eluting stent and were prescribed dual antiplatelet therapy. All patients received aspirin. The primary study outcome was a 3-level variable denoting the second antiplatelet agent prescribed: (1) clopidogrel, (2) prasugrel, or (3) ticagrelor. Baseline characteristics were compared among the 3 groups. Odds ratios and 95% credible intervals were calculated from a nested hierarchical Bayesian logistic regression models to identify independent predictors of prescription of antiplatelet medications, incorporating practice and provider as random effects. Our study cohort consisted of 26,710 patients during our study period January 2013 to March 2015. Seventy nine percent of patients were prescribed clopidogrel, 12% prasugrel, and 11% ticagrelor. Patients aged ≥75 years, women, history of tobacco use, Peripheral Arterial Disease (PAD), hypertension, diabetes, previous vascular complication, heart failure, and stroke/transient ischemic attack were more likely to be on clopidogrel than prasugrel or ticagrelor. The relative percentages of ticagrelor and prasugrel were higher in patients with history of myocardial infarction, compared with those without myocardial infarction. In summary, our study highlights the prescription patterns associated with prescription of antiplatelet agents after PCI. We found that both ticagrelor and prasugrel were mostly prescribed per the current practice guidelines, thus reflecting appropriate guideline adherence by practices in NCDR PINNACLE registry.

• Authors: Umair Khalid, Salman Bandeali, Philip G Jones, Salim S Virani, Ravi Hira, Ihab Hamzeh, Paul S Chan, Neal S Kleiman, Nasser Lakkis, Mahboob Alam
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 124 Issue 12 Pg. 1807-1812 (12 15 2019) ISSN: 1879-1913 [Electronic] United States
• PMID: 31668345 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• Prasugrel Hydrochloride
• Ticagrelor

Topics

• Aged
• Bayes Theorem
• Clopidogrel (therapeutic use)
• Cohort Studies
• Combined Modality Therapy
• Coronary Angiography (methods)
• Coronary Stenosis (diagnostic imaging, mortality, therapy)
• Drug Utilization (statistics & numerical data)
• Drug-Eluting Stents
• Female
• Humans
• Logistic Models
• Male
• Middle Aged
• Percutaneous Coronary Intervention (methods)
• Platelet Aggregation Inhibitors (therapeutic use)
• Prasugrel Hydrochloride (therapeutic use)
• Prescriptions (statistics & numerical data)
• Registries
• Retrospective Studies
• Severity of Illness Index
• Survival Analysis
• Ticagrelor (therapeutic use)
• Treatment Outcome
• United States