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International Patterns of DAPT Duration After ACS
Study Questions:
What are the international patterns of dual antiplatelet therapy (DAPT) duration after acute coronary syndrome (ACS)?
Methods:
EPICOR (long-tErm follow-uP of anti-thrombotic management patterns In acute CORonary syndrome patients) is a prospective, international, observational study of 10,568 ACS hospital survivors enrolled in 555 centers from 20 countries across Europe and Latin America between 2010 and 2011, with telephone follow-up at quarterly intervals up to 24 months to assess treatment continuation and clinical events.
Results:
Of 8,593 patients discharged on DAPT, 4,859 (57%) remained on uninterrupted DAPT at the end of follow-up. There were minor differences in rates of DAPT discontinuation according to age, gender, risk factors, therapeutic strategy, or region, but major differences between countries. By study end, 555 of evaluable patients (5.7%) died, 727 (10.0%) experienced new cardiovascular (CV) events, 496 new coronary events (6.82%), and 154 (2.11%) clinically relevant bleeding (14 [6.7%] fatal). Most CV events and deaths (85%) occurred while on DAPT. DAPT interruption was associated with increased risk of CV events in the following week (hazard ratio, 2.29; 95% confidence interval, 1.08-4.84), but not specifically with time to first coronary event or mortality.
Conclusions:
The authors concluded that despite guideline recommendations, most patients with ACS in Europe and Latin America remained on DAPT beyond 12 months, with country being the most important determinant of DAPT duration.
Perspective:
This study reports that a high proportion of patients with ACS in Europe and Latin America were receiving DAPT beyond 12 months, suggesting local systems as an important driver of DAPT duration. Discontinuation of DAPT was associated with a short-term increase in overall CV risk, but not with any long-term increase in coronary events or mortality. These findings underscore the importance of postmarketing surveillance to monitor prescription patterns, patient selection, and clinical events related to long-term DAPT duration, and a need to follow compliance with guideline recommendations and develop interventions to improve these.
Keywords: Acute Coronary Syndrome, Coronary Artery Disease, Europe, Hemorrhage, Latin America, Patient Discharge, Platelet Aggregation Inhibitors, Risk Factors, Secondary Prevention, Survivors, Thrombosis, Treatment Outcome
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