Benefit of switching dual antiplatelet therapy after ACS on dual antiplatelet therapy adherence: A prespecified analysis of the TOPIC randomized study - 05/01/18
, J. Quilci 2, C. Bassez 1, G. Bonnet 3, M. Lambert 1, P. Morange 1, M.C. Alessi 1, L. Fourcade 2, J. Bonnet 4, T. Cuisset 1Bienvenue sur EM-consulte, la référence des professionnels de santé.
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Résumé |
Background |
The Timing Of Platelet Inhibition after acute Coronary Syndrome (TOPIC) trial showed that switching dual antiplatelet (DAPT) from aspirin plus a newer P2Y12 blocker (prasugrel or ticagrelor) to aspirin plus clopidogrel 1 month after an acute coronary syndrome (ACS) led to a reduction in bleeding complications with similar risk of ischemic recurrence.
Purpose |
The objective of this prespecified analysis was to evaluate the impact of switching strategy on DAPT adherence.
Methods |
TOPIC study randomized patients admitted for an ACS without adverse event at 1 month on aspirin and a newer P2Y12 blocker, to aspirin and clopidogrel (switched DAPT) or continuation of their drug regimen (unchanged DAPT). Medical adherence to prescribed DAPT was assessed at 6 months and 1 year.
Results |
Six hundred and forty-six patients were randomized and 645 analyzed, corresponding to 322 patients in the switched DAPT and 323 in the unchanged DAPT group. At 6 months and 1 year, the allocated DAPT regimen was significantly used more often in the switched group than in the unchanged DAPT group: 298 (92.5%) vs. 264 (81.7%) (P<0.01) at 6 months and 277 (87.7%) vs. and 242 (76.1%) (P<0.01) at 1 year. The reason for DAPT change was related to an adverse event in 66% of cases corresponding to an ischemic event in 17 patients (14.8%) and bleeding in 59 patients (51.3%) (Fig. 1). In multivariable analysis, unchanged DAPT strategy and ischemic or bleeding events were significantly associated with non-adherence to prescribed DAPT (Table 1).
Conclusion |
A switched DAPT was associated with significant improvement in the number of patients on prescribed DAPT at 6 months and 1 year following ACS. This improved adherence was related to reduction of side effects.
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Vol 10 - N° 1
P. 8-9 - janvier 2018 Retour au numéro
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