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Observational Study
. 2019 Jun 3;9(1):8194.
doi: 10.1038/s41598-019-44673-7.

Incidence, predictors, and prognosis of premature discontinuation or switch of prasugrel or ticagrelor: the ATLANTIS - SWITCH study

Max-Paul Winter  1 , Dirk von Lewinski  2 , Markus Wallner  2   3 , Florian Prüller  4 , Ewald Kolesnik  2 , Christian Hengstenberg  1 , Jolanta M Siller-Matula  5
Affiliations
Observational Study

Incidence, predictors, and prognosis of premature discontinuation or switch of prasugrel or ticagrelor: the ATLANTIS - SWITCH study

Max-Paul Winter et al. Sci Rep. .

Abstract

Aim of the present study was to investigate the frequency and predictors of premature discontinuation or switch of ADP receptor blockers and its association with serious adverse events. For this purpose 571 consecutive ACS patients receiving ticagrelor (n = 258, 45%) or prasugrel (n = 313, 55%) undergoing PCI were enrolled in this prospective, observational, multicenter ATLANTIS-SWITCH substudy. Predictors of premature discontinuation or switch of antiplatelet therapy and their association with major adverse cardiovascular events and TIMI bleeding events were evaluated. Premature stop/switch was found in 72 (12.6%) patients: 34 (5.9%) stopped and 38 (6.7%) switched the ADP blocker. Ticagrelor treated patients were significantly more likely to stop/switch therapy as compared to prasugrel (15.9% vs. 9.2%, p = 0.016). We identified 4 independent predictors for stop/switch of ADP blocker: major surgery, need for oral anticoagulation (OAC), TIMI major bleeding and drug intolerance. TIMI major bleeding was a driver of stop/switch actions and occurred in 4.3% vs 0.2% in patients with vs without stop/switch (p = 0.001). The majority of stop/switch actions (75%) were physicians driven decisions. Importantly, stop/switch of therapy was not associated with increased risk of MACE (p = 0.936). In conclusion premature switch/stop of ADP blockers appears to be safe when mainly driven by physician's decision and clinical indication.

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Conflict of interest statement

M.P.W., D.v.L., M.W., F.P., E.K., C.H. and J.S.M. received honoraries for Advisory Boards by AstraZeneca and Daiichi Sankyo. The author declare no competing interests.

Figures

Figure 1
Figure 1
Kaplan Meier Time-to-Event curve for the occurrence of premature ADP-blocker discontinuation or switch.
Figure 2
Figure 2
Kaplan Meier Time-to-Event curve for the occurrence of premature ADP -blocker stop.
Figure 3
Figure 3
Switching regime according to initial ADP-blocker and subsequent bleeding events.
Figure 4
Figure 4
Kaplan Meier Time-to-Event curve for the occurrence of ADP-blocker switch for the whole observational period (A) and the initial phase of 60 days (B).
See this image and copyright information in PMC

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