Are Physicians Making Full Use of P2Y12 Drugs?

In high-risk patients with acute coronary syndrome (ACS) prasugrel and ticagrelor have been shown to be more effective than clopidogrel in preventing thrombotic events.

A team from the Icahn School of Medicine at Mount Sinai in New York City set out to see what the determinants and patterns of use might be in real-world patients undergoing percutaneous coronary intervention.

The researchers found physicians are giving the newer drugs mostly to lower-risk, younger patients.

Reporting at the American College of Cardiology’s 65^th Scientific Session & Expo in Chicago, IL, Raman Sharma and colleagues looked at 11,982 patients undergoing PCI at their center.

They compared baseline characteristics of patients getting clopidogrel vs. ticagrelor or prasugrel.

Independent factors related to receiving these potent P2Y12 inhibitors were identified using multivariable logistic regression.

They found that compared to patients receiving clopidogrel (9,817 patients) those getting the P2Y12 inhibitors (2,165) were younger and had fewer comorbidities including hypertension, chronic kidney disease and anemia.

“Only 32% of STEMI patients were discharged on either agent,” they noted.

The strongest demographic clinical and procedural determinants of which patients got prasugrel or ticagrelor were being under age 70, having cerebrovascular disease, and use of a bare metal stent.

The findings “highlight a lack of calibration between ischemic risk and intensity of antiplatelet pharmacotherapy,” they concluded.