Early clopidogrel versus prasugrel use among contemporary STEMI and NSTEMI patients in the US: insights from the National Cardiovascular Data Registry.

Sherwood, Matthew W

Wiviott, Stephen D

Peng, S Andrew

Roe, Matthew T

Delemos, James

Peterson, Eric D

Wang, Tracy Y

England

2015-07-25T15:26:42Z

2014-04-14

BACKGROUND: P2Y12 antagonist therapy improves outcomes in acute myocardial infarction (MI) patients. Novel agents in this class are now available in the US. We studied the introduction of prasugrel into contemporary MI practice to understand the appropriateness of its use and assess for changes in antiplatelet management practices. METHODS AND RESULTS: Using ACTION Registry-GWTG (Get-with-the-Guidelines), we evaluated patterns of P2Y12 antagonist use within 24 hours of admission in 100 228 ST elevation myocardial infarction (STEMI) and 158 492 Non-ST elevation myocardial infarction (NSTEMI) patients at 548 hospitals between October 2009 and September 2012. Rates of early P2Y12 antagonist use were approximately 90% among STEMI and 57% among NSTEMI patients. From 2009 to 2012, prasugrel use increased significantly from 3% to 18% (5% to 30% in STEMI; 2% to 10% in NSTEMI; P for trend <0.001 for all). During the same period, we observed a decrease in use of early but not discharge P2Y12 antagonist among NSTEMI patients. Although contraindicated, 3.0% of patients with prior stroke received prasugrel. Prasugrel was used in 1.9% of patients ≥75 years and 4.5% of patients with weight <60 kg. In both STEMI and NSTEMI, prasugrel was most frequently used in patients at the lowest predicted risk for bleeding and mortality. Despite lack of supporting evidence, prasugrel was initiated before cardiac catheterization in 18% of NSTEMI patients. CONCLUSIONS: With prasugrel as an antiplatelet treatment option, contemporary practice shows low uptake of prasugrel and delays in P2Y12 antagonist initiation among NSTEMI patients. We also note concerning evidence of inappropriate use of prasugrel, and inadequate targeting of this more potent therapy to maximize the benefit/risk ratio.

http://www.ncbi.nlm.nih.gov/pubmed/24732921

jah3499

2047-9980

https://hdl.handle.net/10161/10320

eng

Ovid Technologies (Wolters Kluwer Health)

J Am Heart Assoc

10.1161/JAHA.114.000849

P2Y12 antagonist

myocardial infarction

prasugrel

Aged

Drug Administration Schedule

Drug Utilization Review

Female

Guideline Adherence

Hemorrhage

Humans

Male

Middle Aged

Myocardial Infarction

Piperazines

Platelet Aggregation Inhibitors

Practice Guidelines as Topic

Practice Patterns, Physicians'

Prasugrel Hydrochloride

Purinergic P2Y Receptor Antagonists

Registries

Retrospective Studies

Thiophenes

Ticlopidine

Time Factors

Treatment Outcome

United States

Early clopidogrel versus prasugrel use among contemporary STEMI and NSTEMI patients in the US: insights from the National Cardiovascular Data Registry.

Journal article

Sherwood, Matthew W|0000-0002-4305-5883

Peterson, Eric D|0000-0002-5415-4721

http://www.ncbi.nlm.nih.gov/pubmed/24732921

e000849

2

Clinical Science Departments

Duke

Duke Clinical Research Institute

Institutes and Centers

Medicine

Medicine, Cardiology

School of Medicine

Published online

3