Evaluation of P2Y12 adenosine diphosphate receptor antagonists in patients with acute coronary syndromes undergoing percutaneous coronary intervention

Purpose: Acute coronary syndrome (ACS) represents a life-threatening form of coronary artery disease and is caused by a rupture of an atherosclerotic plaque or thrombosis of the infarcted artery. Current guidelines highlight the role of dual antiplatelet therapy in those undergoing medical and invasive strategy, particularly percutaneous coronary intervention (PCI) to reduce the risk of ischemic complications. The objective of this study is to compare the clinical safety and efficacy of three P2Y₁₂adenosine diphosphate receptor antagonists; clopidogrel, prasugrel and ticagrelor.

Methods: A retrospective analysis was performed on information extracted from a computerized physician order entry system, medical charts and CathPCI registry in patients with ACS undergoing PCI. Thirty day efficacy endpoints included mortality, stent thrombosis and patient readmission. Safety endpoints included bleeds within 72 hours and 30-day bleeds.

Results: A total of 102 patients were analyzed (50 in the clopidogrel arm, 36 in the prasugrel arm and 16 in the ticagrelor arm). The primary endpoints, mortality and stent thrombosis did not occur in any patient. Readmissions occurred in 8% (4/50) of patients receiving clopidogrel, 39% (14/36) of patients receiving prasugrel and 19% (3/16) in patients receiving ticagrelor (p = 0.328). A bleeding event within 72 hours occurred in 2% (1/50) of patients receiving clopidogrel, 8.3% (3/36) of patients receiving prasugrel and none in ticagrelor. Thirty day bleeds occurred in 4% (2/50) of patients receiving clopidogrel, 2.8% (1/36) of patients receiving prasugrel and none for the ticagrelor arm.

Conclusion: Mortality and stent thrombosis were not observed in the patients analyzed. Prasugrel was associated with a numerically higher rate of readmission compared to clopidogrel and ticagrelor. More patients in the prasugrel group experienced bleeds within 72 hours compared to clopidogrel and ticagrelor. Thirty day bleeds occurred more frequently in patients receiving clopidogrel, followed by prasugrel and none in the ticagrelor arm.