Professor Gunnar Gislasen, Gentofte University Hospital, Denmark, talks to Cardio Debate about his recent study that investigates the differences in dual anti-platelet treatment for acute coronary syndrome in patients undergoing PCI or not.
Well this is a register-based nationwide study from Denmark. We wanted to look at the persistence with dual antiplatelet therapy in patients with acute coronary syndrome.
We know that the guidelines recommended at least 12 months period of dual antiplatelet therapy for all patients after acute coronary syndrome. We have done a similar study in the early clodipogrel period, where we found that especially patients not undergoing revascularization, had no persistence on dual antiplatelet therapy, shorter treatment duration and less often started on therapy.
Now we have three different ADP receptor blockers available – clopidogrel, prasugrel and ticagrelor. So what we did, we identified all patients admitted with acute coronary syndrome – that is myocardial infarction and unstable angina – and we included in total 9700 patients, mainly patients with myocardial infarction, 90 per cent (8700 patients), and 1100 patients with unstable angina.
What we found, that patients not undergoing revascularization were less seldom started on dual antiplatelet therapy, especially among patients with unstable angina. And in total 30 per cent of patients were not started on dual antiplatelet therapy. When we looked at the persistence we found that approximately 30 per cent of patients stopped dual antiplatelet therapy after the first 60 days of treatment, especially among patients not undergoing revascularization.
So the conclusion of the study is that we need to be more focused on using dual antiplatelet therapy, starting patients on treatment and improving persistence, especially among patients not undergoing revascularization.
How will these findings impact on clinical practice?
Well the impact is that this is a treatment that we know prevents recurrent vascular events. We need to focus on patients where they are more likely to start treatment. We also need to focus on the individuals that we are not starting on therapy, and identify the reasons among doctors and health care personnel why they are not starting treatment. And then to secure long-term treatment – at least for most patients 12 months of treatment – we now need to focus on those patients that are most likely to discontinue treatment prematurely.