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Acute coronary syndrome: The effect of platelet inhibitors varies greatly

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(Vienna/Barcelona, 28 August 2017) – Platelet inhibiting treatments with P2Y12 antagonists given following acute coronary syndrome (unstable angina pectoris, heart attack) to prevent the formation a thrombus in a coronary artery can produce very different results, depending upon the drug that is used. The cumulative incidence of a further hospital stay for acute coronary syndrome or death within a two-year period was 18.7% for patients treated with clopidogrel, 8.7% for patients treated with prasugrel and 12% for those treated with ticagrelor. This was reported by lead author of the study, Safoura Sheikh Rezaei, junior doctor for internal medicine at MedUni Vienna, speaking about the study presented at the European Society of Cardiology (ESC) Congress.

The coded data of 72,676 patients discharged following a hospital stay with a diagnosis of acute coronary syndrome in the years 2009 – 2014, were evaluated. The analysis included 32,830 patients with a first prescription of a P2Y12 inhibitor within the first 30 days following the index diagnosis of acute coronary syndrome. The percentage of patients treated with clopidogrel, prasugrel or ticagrelor was 56.8%, 20.4% and 22.9% respectively. The average duration of treatment was 12 months. 4,975 events occurred in 32,174 patients within a follow-up period of 25 months.

"The average duration of treatment with P2Y12 antagonists in patients with acute coronary syndrome in Austria corresponds to the European guidelines on drug treatment following acute coronary syndrome," explains Safoura Sheikh Rezaei. "It would appear that there is a lower incidence of cardiac events in patients treated with prasugrel and ticagrelor, which have increasingly been used since they came onto the market, as opposed to clopidogrel. Clopidogrel is still frequently used for patients at risk of bleeding complications or interactions."

According to the study author, the optimum duration of treatment with P2Y12 inhibitors is somewhat controversial when it comes to the benefits, bleeding risk and drug costs: "The purpose of our epidemiological study was to investigate the duration of treatment and number of new cardiac events in Austrian patients after acute coronary syndrome."

Clopidogrel, prasugrel or ticagrelor use and clinical outcome in patients with acute coronary syndrome: a nationwide long-term registry analysis from 2009 to 2014