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Ray A, Najmi A, Khandelwal G, Jhaj R, Sadasivam B. Comparative effectiveness and safety of prasugrel and ticagrelor in patients of acute coronary syndrome undergoing percutaneous transluminal coronary angioplasty: A propensity score-matched analysis. Indian Heart J 2024; 76:133-135. [PMID: 38485052 PMCID: PMC11143503 DOI: 10.1016/j.ihj.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 02/02/2024] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
Evidence on comparative effectiveness and safety of prasugrel and ticagrelor post-percutaneous transluminal coronary angioplasty is scarce in Indian population. In a 1:1 propensity score-matched cohort with 71 individuals in each group, the incidence of a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or coronary revascularization was not significantly different in prasugrel and ticagrelor group (7.04% vs 9.86%; absolute difference, 2.8%; HR, 0.65; 95% CI, 0.21-2.1; p = 0.49). There was no significant difference in bleeding (5.63% vs 9.86%; absolute difference, -4.20%; 95% CI, -13.0%-4.5%) and dyspnea (7.04% vs 12.7%; absolute difference, -5.60%; 95% CI, -15.4%-4.1%).
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Affiliation(s)
- Avik Ray
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Ahmad Najmi
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India.
| | - Gaurav Khandelwal
- Department of Cardiology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India.
| | - Ratinder Jhaj
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India.
| | - Balakrishnan Sadasivam
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India.
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Senguttuvan NB, Sankaran R, Rajeev Y, Thaiyal D, Mathew A, Dharsini K, Marcelene D, Kalsingh MJ, Sahu SK, Sampath A, Prem Kumar KJ, Parthasarathy H, Louis A, Gnanaraj A, Reddy KN, Abraham KA. Effect of discontinuation of ticagrelor and switching-over to other P2Y12 agents in patients with acute coronary syndrome: a single-center real-world experience from India. Egypt Heart J 2021; 73:7. [PMID: 33428005 PMCID: PMC7801539 DOI: 10.1186/s43044-020-00128-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/16/2020] [Indexed: 12/31/2022] Open
Abstract
Background Dual antiplatelet therapy is the current standard of care after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). We intended to study the pattern of use of ticagrelor in patients with acute coronary syndrome undergoing PCI and the effect of switching over to other P2Y12 receptor inhibition on clinical outcomes. Results All patients aged > 18 years who had been admitted with acute coronary syndrome and had been provided ticagrelor as the second antiplatelet agent were included as study participants. The primary outcome of the study was the composite outcome of death, recurrent myocardial infarctions, re-intervention, and major bleeding. We studied 321 patients (54 female patients, 16.82%). The mean age of the patients was 56.65 ± 11.01 years. Ticagrelor was stopped in 76.7% on follow-up. It was stopped in 6.3%, 13.5%, 13.1%, 21.9%, and 45.1% of patients during the first month but after discharge, between first and third months, between 3 and 6 months, between 6 and 12 months, and after 12 months, respectively. In the majority of patients, ticagrelor was replaced by clopidogrel (97.9%). It was stopped according to the physician’s discretion in 79.3% of patients, whereas it was the cost of the drug that made the patient to get swapped to another agent in 18.6%. No difference in the primary composite outcome was observed between the groups where ticagrelor was continued post 12 months and ticagrelor was continued and ticagrelor was switched-over to another agent. Similarly, no difference in death, recurrent myocardial infarctions, re-interventions, or major bleeding manifestations was observed between the two groups. Conclusion In patients with acute coronary syndrome who undergo PCI, we observed that early discontinuation of ticagrelor and switching over to other P2Y12 inhibitors after discharge did not affect clinical outcomes.
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Affiliation(s)
- Nagendra Boopathy Senguttuvan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India. .,Adjunct Faculty-Indian Institute of Technology Madras, Chennai, Tamil Nadu, India. .,Department of Cardiology, Apollo Specialty Hospitals, Chennai, Tamil Nadu, India.
| | - Ramesh Sankaran
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Yashasvi Rajeev
- Department of Cardiology, Jaswant Rai Specialty Hospitals, Chennai, Tamil Nadu, India
| | - Devi Thaiyal
- Department of Cardiology, Apollo Specialty Hospitals, Chennai, Tamil Nadu, India
| | - Angel Mathew
- Department of Cardiology, Apollo Specialty Hospitals, Chennai, Tamil Nadu, India
| | - K Dharsini
- Department of Cardiology, Apollo Specialty Hospitals, Chennai, Tamil Nadu, India
| | - Divya Marcelene
- Department of Cardiology, Apollo Specialty Hospitals, Chennai, Tamil Nadu, India
| | | | - Sujit Kumar Sahu
- Department of Cardiology, Apollo Specialty Hospitals, Chennai, Tamil Nadu, India
| | - Aravind Sampath
- Department of Cardiology, Apollo Specialty Hospitals, Chennai, Tamil Nadu, India
| | - K J Prem Kumar
- Department of Cardiology, Apollo Specialty Hospitals, Chennai, Tamil Nadu, India
| | | | - Amal Louis
- Department of Cardiology, Apollo Specialty Hospitals, Chennai, Tamil Nadu, India
| | - Anand Gnanaraj
- Department of Cardiology, Apollo Specialty Hospitals, Chennai, Tamil Nadu, India
| | - K N Reddy
- Department of Cardiology, Apollo Specialty Hospitals, Chennai, Tamil Nadu, India
| | - K A Abraham
- Department of Cardiology, Apollo Specialty Hospitals, Chennai, Tamil Nadu, India
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Gupta R, Khedar RS, Gaur K, Xavier D. Low quality cardiovascular care is important coronary risk factor in India. Indian Heart J 2018; 70 Suppl 3:S419-S430. [PMID: 30595301 PMCID: PMC6309144 DOI: 10.1016/j.ihj.2018.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 05/03/2018] [Indexed: 01/12/2023] Open
Abstract
Global Burden of Disease study has reported that cardiovascular and ischemic heart disease (IHD) mortality has increased by 34% in last 25 years in India. It has also been reported that despite having lower coronary risk factors compared to developed countries, incident cardiovascular mortality, cardiovascular events and case-fatality are greater in India. Reasons for the increasing trends and high mortality have not been studied. There is evidence that social determinants of IHD risk factors are widely prevalent and increasing. Epidemiological studies have reported low control rates of hypertension, hypercholesterolemia, diabetes and smoking/tobacco. Registries have reported greater mortality of acute coronary syndrome in India compared to developed countries. Secondary prevention therapies have significant gaps. Low quality cardiovascular care is an important risk factor in India. Package of interventions focusing on fiscal, intersectoral and public health measures, improvement of health services at community, primary and secondary healthcare levels and appropriate referral systems to specialized hospitals is urgently required.
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Affiliation(s)
- Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Mount Sinai New York Affiliate, Jaipur, India.
| | - Raghubir S Khedar
- Eternal Heart Care Centre & Research Institute, Mount Sinai New York Affiliate, Jaipur, India
| | - Kiran Gaur
- Department of Statistics, SKN Agricultural University, Jobner, Jaipur, India
| | - Denis Xavier
- Department of Pharmacology, St John's Medical College, Bangalore, India
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Sedat J, Chau Y, Gaudart J, Sachet M, Beuil S, Lonjon M. Prasugrel versus clopidogrel in stent-assisted coil embolization of unruptured intracranial aneurysms. Interv Neuroradiol 2017; 23:52-59. [PMID: 27760885 PMCID: PMC5305152 DOI: 10.1177/1591019916669090] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/22/2016] [Indexed: 12/11/2022] Open
Abstract
Background Thromboembolic complications are the main problem in stent-assisted coil embolization of unruptured intracranial aneurysms. The combination of aspirin and clopidogrel is generally used to decrease these complications, but some patients do not respond to clopidogrel and have a higher risk of stent thrombosis. In cardiology, clinical trials have shown that prasugrel reduced the incidence of ischaemic events in patients with acute coronary syndrome compared with clopidogrel but, according to several authors, prasugrel would produce an increased risk of cerebral haemorrhagic complications. Objective The purpose of this study was to determine whether prasugrel would be more effective than clopidogrel in reducing procedural events in patients with an unruptured aneurysm treated endovascularly with coils and stent. Materials and methods Two hundred consecutive patients with intracranial aneurysms were treated using coiling and stenting procedures. The first 100 patients were administered a dual antiplatelet of aspirin and clopidogrel, while the remaining 100 patients were administered a dual antiplatelet of aspirin and prasugrel. In each group data were collected on procedural and periprocedural haemorrhagic and ischaemic complications. Results Aneurysmal occlusion and haemorrhagic complications rates were identical in both groups. The number of thromboembolic events observed in the two groups of our study did not differ significantly, but the prasugrel group included more wide-neck aneurysms and more flow-diverted stents. Moreover, complications in the prasugrel group were more benign, explaining the significant difference in clinical outcomes between the two groups on Day 30. Conclusions Prasugrel reduces the clinical consequences of thromboembolic complications of endovascular treatment with stenting and coiling of unruptured intracranial aneurysms.
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Affiliation(s)
- Jacques Sedat
- Unité de NeuroInterventionnelle, Hôpital St Roch, France
| | - Yves Chau
- Unité de NeuroInterventionnelle, Hôpital St Roch, France
| | - Jean Gaudart
- Service de santé publique et d’information, Médicale Hôpital La Timone, France
| | - Marina Sachet
- Unité de NeuroInterventionnelle, Hôpital St Roch, France
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Cader FA, Haq MM, Nasrin S, Karim MR. Pericardial tamponade due to haemorrhagic pericardial effusion as a complication of prasugrel: a case report. BMC Cardiovasc Disord 2016; 16:162. [PMID: 27577194 PMCID: PMC5006429 DOI: 10.1186/s12872-016-0338-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 07/01/2016] [Indexed: 01/23/2023] Open
Abstract
Background Striking an adequate balance between bleeding risks and prevention of stent thrombosis can be challenging in the setting of percutaneous coronary intervention (PCI) with drug eluting stents (DES) in acute myocardial infarction (MI). This is more pronounced in patients treated with both low molecular weight heparin (LMWH) and dual antiplatelet therapy (DAPT). Prasugrel, a second generation thienopyridine with more potent platelet inhibition capability, is associated with significant bleeding risks. This risk of bleeding is often underestimated when prescribing pharmacological agents such as DAPT and LMWH, designed to reduce ischaemic events following PCI in acute MI. Life-threatening haemorrhagic pericardial and pleural effusions not associated with access site bleeding are a rare example of such bleeding complications. Case presentation We report a case of a Bangladeshi male who developed cardiac tamponade resulting from haemorrhagic pericardial effusion as well as bilateral pleural effusions, 9 days after PCI with a DES, while on prasugrel and aspirin. He had presented late with inferior ST elevation myocardial infarction (STEMI), and was therefore also given enoxaparin initially. Haemorrhagic pericardial and pleural fluid were drained, and the patient was discharged on DAPT comprising of aspirin and clopidogrel. Following PCI to obtuse marginal, which was done as a staged procedure 6 months later, he was commenced on ticagrelor instead of clopidogrel. He developed no further bleeding complications over 1 year of follow up. Conclusion Non-access site bleeding such as this, leading to haemorrhagic pericardial and pleural effusions can be rare and life-threatening. Furthermore, patients with acute coronary syndromes (ACS) have marked variation in their risk of major bleeding. Since haemorrhagic complications are associated with mortality, maintaining a balance between the risk of recurrent ischemia and that of bleeding is of paramount importance. The use of validated bleeding risk scores, careful monitoring of patients on DAPT with LMWH, or a switch over to agents with lesser risk of bleeding may reduce such complications.
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Affiliation(s)
- Fathima Aaysha Cader
- Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Shahbagh, Dhaka, 1000, Bangladesh. .,National Institute of Cardiovascular Diseases, Dhaka, Bangladesh.
| | - M Maksumul Haq
- Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Shahbagh, Dhaka, 1000, Bangladesh
| | - Sahela Nasrin
- Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Shahbagh, Dhaka, 1000, Bangladesh
| | - Md Rezaul Karim
- Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Shahbagh, Dhaka, 1000, Bangladesh
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