Contraindications/special warnings and precautions for use of contemporary oral antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention

• Published in: Circulation journal : official journal of the Japanese Circulation Society Vol. 78; no. 1; pp. 180 - 187
• Main Authors: Alexopoulos, Dimitrios, Xanthopoulou, Ioanna, Deftereos, Spyridon, Sitafidis, George, Kanakakis, Ioannis, Hamilos, Michalis, Vavuranakis, Manolis, Davlouros, Periklis, Ntalas, Ioannis, Angelidis, Christos, Hahalis, George, Triposkiadis, Filippos, Vardas, Panos, Stefanadis, Christodoulos, Goudevenos, John A
• Format: Journal Article
• Language: English
• Published: Japan 2014
• Subjects: Acute Coronary Syndrome - drug therapy; Acute Coronary Syndrome - surgery; Administration, Oral; Age Factors; Aged; Female; Hemorrhage - chemically induced; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Receptors, Purinergic P2Y12 - blood; Registries
• ISSN: 1347-4820

The prevalence of contraindications/special warnings and precautions (CON/SWP) for clopidogrel, prasugrel and ticagrelor use is not adequately studied and might affect P2Y12 inhibitor choice in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). In the context of the GReek AntiPlatelet rEgistry (GRAPE) a detailed recording of CON/SWP for use of clopidogrel, prasugrel and ticagrelor was done for 1,280 consecutive, moderate-high-risk ACS patients undergoing PCI. At least 1 CON for use of clopidogrel, prasugrel and ticagrelor was present in 5 (0.4%), 49 (3.8%) and 12 patients (0.9%), respectively. Prevalence of at least 1 CON/SWP to clopidogrel (45.8%) was less frequent compared to prasugrel (49.1%) or ticagrelor (49.1%; P=0.02 and P=0.04, respectively), while 34% of patients had at least 1 CON/SWP to all the 3 P2Y12 inhibitors. At discharge, 482 (38.6%), 301 (24.1%) and 464 patients (37.2%) received clopidogrel, prasugrel and ticagrelor, respectively. Age ≥75 years, co-medication related to increased bleeding risk, and history of asthma/chronic obstructive pulmonary disease favored clopidogrel vs. prasugrel or ticagrelor use as discharge medication, while geographic region also affected this choice (C-statistic, 0.81; 95% CI: 0.78-0.83). In patients with ACS undergoing PCI the prevalence of CON to antiplatelet agents is low, whereas that of SWP is high. Certain SWP, along with regional trends may affect the choice of newer P2Y12 inhibitors vs. clopidogrel.