The antiplatelet agent clopidogrel may be used more often that newer antiplatelet therapies ticagrelor and prasugrel following PCI procedures, according to a study published recently in the American Journal of Cardiology.

Using data from ACC and Veradigm's PINNACLE Registry, Umair Khalid, MD, et al., evaluated patient characteristics and provider/practice factors associated with prescriptions for newer antiplatelet agents in patients who underwent PCI with a drug-eluting stent and received prescriptions for dual antiplatelet therapy. All patients received aspirin. The researchers assessed whether patients were prescribed clopidogrel, prasugrel or ticagrelor for the second antiplatelet agent and compared baseline characteristics among the three groups.

Of 26,710 patients, 21,024 (79 percent) received clopidogrel, 3,131 (12 percent) received prasugrel and 2,555 (11 percent) received ticagrelor. Patients who were women, were older than 75, had prior tobacco use or a history of peripheral arterial disease, hypertension, diabetes, previous vascular complications, heart failure and stroke were more like to be prescribed clopidogrel vs. prasugrel or ticagrelor. A larger percentage of patients with a history of prior myocardial infarction (MI) took prasugrel or ticagrelor vs. those without a previous MI. Between the newer agents, ticagrelor was more likely to be prescribed in patients age 75 or older with a history of MI and less likely to be prescribed to patients whose body mass index was higher than 25 kg/m.

The researchers note that their findings show that older patients were more likely to be prescribed clopidogrel than prasugrel or ticagrelor, suggesting that providers may be more comfortable prescribing clopidogrel than newer medications in high-risk elderly populations with increased bleeding risk. They conclude that ticagrelor and prasugrel were mostly prescribed per current guidelines and that clopidogrel was used far more often than the newer agents.

Clinical Topics: Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure, Interventions and Vascular Medicine, Hypertension

Keywords: Platelet Aggregation Inhibitors, Aspirin, Drug-Eluting Stents, Peripheral Arterial Disease, Percutaneous Coronary Intervention, Myocardial Infarction, Registries, National Cardiovascular Data Registries, PINNACLE Registry, Stroke, Heart Failure, Diabetes Mellitus, Hypertension

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