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Southern Saskatchewan Ticagrelor Registry experience.

Dehghani P, Chopra V, Bell A, Kelly S, Zulyniak L, Booker J, Zimmermann R, Semchuk W, Cheema AN, Lavoie AJ - Patient Prefer Adherence (2014)

Bottom Line: A composite outcome event of death from vascular causes, myocardial infarction, or stroke occurred in 8.8% of the entire cohort and was more likely to occur in those older then 65 years, those presenting with cardiogenic shock, and those who prematurely stopped ticagrelor.In this real-world registry of patients started on ticagrelor, a third have off-label indications and a fifth prematurely stop the medication.Premature discontinuation was an independent predictor of major life-threatening bleeding and increased composite event rate of death from vascular causes, myocardial infarction, or stroke.

View Article: PubMed Central - PubMed

Affiliation: Prairie Vascular Research Network, University of Saskatchewan, Regina, SK, Canada.

ABSTRACT

Background: As ticagrelor enters into clinical use for acute coronary syndrome, it is important to understand patient/physician behavior in terms of appropriate use, adherence, and event rates.

Methods: The Southern Saskatchewan Ticagrelor Registry is a prospective, observational, multicenter cohort study that identifies consecutive patients started on ticagrelor. We aimed to evaluate both on- and off-label use, identify characteristics of patients who prematurely stop ticagrelor, and describe patient/physician behavior contributing to inappropriate stoppage of this medication.

Results: From April 2012 to September 2013, 227 patients were initiated on ticagrelor, with a mean age of 62.2±12.1 years. The participants were 66% men and had a mean follow up of 157.4±111.7 days. Seventy-four patients (32.4%) had off-label indications. Forty-seven patients (20.7%) prematurely stopped ticagrelor and were more likely to be older, women, nonwhite, present with shock, and complain of dyspnea. Twenty-six of the 47 patients stopped ticagrelor inappropriately because of patient nonadherence (18 patients) and physician advice (eight patients). A composite outcome event of death from vascular causes, myocardial infarction, or stroke occurred in 8.8% of the entire cohort and was more likely to occur in those older then 65 years, those presenting with cardiogenic shock, and those who prematurely stopped ticagrelor.

Conclusion: In this real-world registry of patients started on ticagrelor, a third have off-label indications and a fifth prematurely stop the medication. Premature discontinuation was an independent predictor of major life-threatening bleeding and increased composite event rate of death from vascular causes, myocardial infarction, or stroke.

No MeSH data available.


Related in: MedlinePlus

Cited reasons for those who stopped taking ticagrelor.Abbreviation: CABG, coronary artery bypass surgery.
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f1-ppa-8-1427: Cited reasons for those who stopped taking ticagrelor.Abbreviation: CABG, coronary artery bypass surgery.

Mentions: Forty-seven patients (20.7%) prematurely stopped taking ticagrelor and, compared with those continuing with ticagrelor, were more likely to be older, women, and nonwhite and to have prior PCI or CABG, present with shock, and complain of dyspnea within the first 4 weeks of starting the medication (Table 1). Of these 47 patients, 18 patients stopped ticagrelor without any input from their cardiologists (three because of dyspnea, ten for reasons unknown, one because of a lack of financial coverage, and four because of coronary artery bypass surgery) with a nonadherence rate of 8.0% (Figure 1). Of the remaining 29 patients, eight were switched by their cardiologists to clopidogrel for reasons not consistent with guideline recommendations (four because of nonlimiting dyspnea, one because of surgical revascularization and fear of excessive bleeding, and three with no reason specified; Figure 1). Therefore, 26 of the 47 patients stopped ticagrelor inappropriately because of patient nonadherence (18 patients) and physician advice (eight patients). The remaining 21 patients stopped ticagrelor or switched to clopidogrel for reasons judged by the investigator to be a result of medication (three had severe dyspnea, five had a significant bleeding event, two had symptomatic ventricular pauses longer than 3 seconds that resolved when switching to clopidogrel, five had coverage for clopidogrel but not ticagrelor, and six developed an indication for Warfarin postpresentation). All patients who had no coverage were of indigenous origin and described themselves as nonwhite.


Southern Saskatchewan Ticagrelor Registry experience.

Dehghani P, Chopra V, Bell A, Kelly S, Zulyniak L, Booker J, Zimmermann R, Semchuk W, Cheema AN, Lavoie AJ - Patient Prefer Adherence (2014)

Cited reasons for those who stopped taking ticagrelor.Abbreviation: CABG, coronary artery bypass surgery.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4206253&req=5

f1-ppa-8-1427: Cited reasons for those who stopped taking ticagrelor.Abbreviation: CABG, coronary artery bypass surgery.
Mentions: Forty-seven patients (20.7%) prematurely stopped taking ticagrelor and, compared with those continuing with ticagrelor, were more likely to be older, women, and nonwhite and to have prior PCI or CABG, present with shock, and complain of dyspnea within the first 4 weeks of starting the medication (Table 1). Of these 47 patients, 18 patients stopped ticagrelor without any input from their cardiologists (three because of dyspnea, ten for reasons unknown, one because of a lack of financial coverage, and four because of coronary artery bypass surgery) with a nonadherence rate of 8.0% (Figure 1). Of the remaining 29 patients, eight were switched by their cardiologists to clopidogrel for reasons not consistent with guideline recommendations (four because of nonlimiting dyspnea, one because of surgical revascularization and fear of excessive bleeding, and three with no reason specified; Figure 1). Therefore, 26 of the 47 patients stopped ticagrelor inappropriately because of patient nonadherence (18 patients) and physician advice (eight patients). The remaining 21 patients stopped ticagrelor or switched to clopidogrel for reasons judged by the investigator to be a result of medication (three had severe dyspnea, five had a significant bleeding event, two had symptomatic ventricular pauses longer than 3 seconds that resolved when switching to clopidogrel, five had coverage for clopidogrel but not ticagrelor, and six developed an indication for Warfarin postpresentation). All patients who had no coverage were of indigenous origin and described themselves as nonwhite.

Bottom Line: A composite outcome event of death from vascular causes, myocardial infarction, or stroke occurred in 8.8% of the entire cohort and was more likely to occur in those older then 65 years, those presenting with cardiogenic shock, and those who prematurely stopped ticagrelor.In this real-world registry of patients started on ticagrelor, a third have off-label indications and a fifth prematurely stop the medication.Premature discontinuation was an independent predictor of major life-threatening bleeding and increased composite event rate of death from vascular causes, myocardial infarction, or stroke.

View Article: PubMed Central - PubMed

Affiliation: Prairie Vascular Research Network, University of Saskatchewan, Regina, SK, Canada.

ABSTRACT

Background: As ticagrelor enters into clinical use for acute coronary syndrome, it is important to understand patient/physician behavior in terms of appropriate use, adherence, and event rates.

Methods: The Southern Saskatchewan Ticagrelor Registry is a prospective, observational, multicenter cohort study that identifies consecutive patients started on ticagrelor. We aimed to evaluate both on- and off-label use, identify characteristics of patients who prematurely stop ticagrelor, and describe patient/physician behavior contributing to inappropriate stoppage of this medication.

Results: From April 2012 to September 2013, 227 patients were initiated on ticagrelor, with a mean age of 62.2±12.1 years. The participants were 66% men and had a mean follow up of 157.4±111.7 days. Seventy-four patients (32.4%) had off-label indications. Forty-seven patients (20.7%) prematurely stopped ticagrelor and were more likely to be older, women, nonwhite, present with shock, and complain of dyspnea. Twenty-six of the 47 patients stopped ticagrelor inappropriately because of patient nonadherence (18 patients) and physician advice (eight patients). A composite outcome event of death from vascular causes, myocardial infarction, or stroke occurred in 8.8% of the entire cohort and was more likely to occur in those older then 65 years, those presenting with cardiogenic shock, and those who prematurely stopped ticagrelor.

Conclusion: In this real-world registry of patients started on ticagrelor, a third have off-label indications and a fifth prematurely stop the medication. Premature discontinuation was an independent predictor of major life-threatening bleeding and increased composite event rate of death from vascular causes, myocardial infarction, or stroke.

No MeSH data available.


Related in: MedlinePlus