Switching of Ticagrelor to Clopidogrel at 3 Months in Patients Treated for Acute Care Syndrome; Single Centre Experience

Abstract

Objective: ESC guidelines recommend Dual Anti-Platelet Therapy (DAPT) with aspirin and ticagrelor for 12 months following Non-ST Elevation Myocardial Infarction (NSTEMI). We aimed to assess the safety of switching DAPT with aspirin and ticagrelor to aspirin and clopidogrel after 3 months in patients following NSTEMI, with the maximum duration of DAPT of 12 months. Material and Methods: Patients admitted with NSTEMI between 2011-2012 were identified using the ICD-10 and OPCS-4 coding systems. Retrospective analysis was then performed using electronic records for additional information. Results: 98 patients were treated with aspirin and ticagrelor following admission with MI. 64% (63/98) were male, 55.1% (54/98) were hypertensive, 66.3% (65/98) with hyperlipidemia, 20.4% (20/98), had diabetes and 33.7% (33/98) had previous known ischemic heart disease, 40.8% (40/98) were ex-smokers, 35.7% (35/98) had BMI > 30. 74.5% (73/98) underwent percutaneous coronary intervention with stenting of the target lesions, 20.4% (20/98) treated medically while 4.1% (4/98) referred for coronary bypass surgery. 8.2% (8/98) patients were re-admitted within 90 days of NSTEMI before the switchover of DAPT (3 for angina, 2 for non-cardiac chest pains and 3 for non-cardiac conditions), and none after that period. In 51% (50/98) patients DAPT was switched to clopidogrel at 3 months with 49% (48/98) staying on aspirin and ticagrelor. There were three non-cardiac deaths in the follow-up period. Conclusion: This study shows the potential for the safe switchover of DAPT to clopidogrel following 3 months therapy with ticagrelor for NSTEMI, whilst enhancing cost-savings.