Long term dual antiplatelet therapy after myocardial infarction: retrospective analysis in an outpatient population

https://doi.org/10.4081/monaldi.2021.1881

Authors

  • Gennaro Ratti | genratti@virgilio.it Cardiology/ICU Department, S. Gennaro Hospital, Naples, Italy.
  • Antonio Maglione Cardiology/ICU Department, S. Gennaro Hospital, Naples, Italy.
  • Emilia Biglietto Cardiology/ICU Department, S. Gennaro Hospital, Naples, Italy.
  • Cinzia Monda Cardiology/ICU Department, S. Gennaro Hospital, Naples, Italy.
  • Ciro Elettrico Cardiology/ICU Department, S. Gennaro Hospital, Naples, Italy.
  • Federica Ratti Cardiac Rehabilitation, S. Gennaro Hospital, Naples, Italy.
  • Cosimo Fulgione Cardiac Rehabilitation, S. Gennaro Hospital, Naples, Italy.
  • Mario Mallardo Cardiology/ICU Department, S. Gennaro Hospital, Naples, Italy.
  • Paolo Tammaro Cardiology/ICU Department, S. Gennaro Hospital, Naples, Italy.

Abstract

Long term treatment with ticagrelor 60 mg and low-dose aspirin are indicated after acute coronary syndrome (ACS). We retrospectively reviewed aggregate data of 187 patients (155 M and 38 F) (mean age 63.8±9 years) in follow up after ACS with at least one high risk condition (Multivessel disease, diabetes, GFR<60 mL/min, history of prior myocardial infarction, age >65 years) treated with ticagrelor 60 mg twice daily (after 90 mg twice daily for 12 months). The results were compared with findings (characteristics of the patients at baseline, outcomes, bleeding) of PEGASUS-TIMI 54 trial and Eu Label. The highrisk groups were represented as follows: multivessel disease 105 pts (82%), diabetes 63 pts (33%), GFR< 60 mL/min 27 pts (14%), history of prior MI 33 pts (17%), >65 year aged 85 pts (45%). Treatment was withdrawn in 7 patients: 3 cases showed atrial fibrillation and were placed on oral anticoagulant drugs, one developed intracranial bleeding, in three patients a temporary withdrawal was due to surgery (1 colon polyposis and 2 cases of bladder papilloma). Chest pain without myocardial infarction occurred in 16 patients (revascularization was required in 9 patients). Dyspnea was present in 15 patients, but was not a cause for discontinuation of therapy. Long term treatment with ticagrelor 60 mg twice daily plus aspirin 100 mg/day showed a favourable benefit/risk profile after ACS.  In this study all patients had been given ticagrelor 90 mg twice daily for 12 months and the 60 mg twice daily dosage was started immediately thereafter, unlike PEGASUS-TIMI 54 trial in which it was prescribed within a period ranging from 1 day to 1 year after discontinuation of the 90 mg dose. This makes our results more consistent with current clinical practice. However, a careful outpatient follow-up and constant counseling are mandatory to check out compliance to therapy and adverse side effects.

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References

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Published
2021-09-16
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Section
Cardiology - Original Articles
Supporting Agencies
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Keywords:
Antiplatelet agents, dual antiplatelet therapy, high ischemic risk, percutaneous coronary intervention
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How to Cite
Ratti, Gennaro, Antonio Maglione, Emilia Biglietto, Cinzia Monda, Ciro Elettrico, Federica Ratti, Cosimo Fulgione, Mario Mallardo, and Paolo Tammaro. 2021. “Long Term Dual Antiplatelet Therapy After Myocardial Infarction: Retrospective Analysis in an Outpatient Population”. Monaldi Archives for Chest Disease, September. https://doi.org/10.4081/monaldi.2021.1881.

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