The choice of the P2Y12 receptors blocker in the treatment of a patient with acute coronary syndrome: practice of N.I. Pirogov city clinical hospital №1

Abstract

Ticagrelor is known to prefer clopidigrel except in cases of high risk of bleeding, but according to the literature, clopidogrel still remains the most frequent second component of dual antiplatelet therapy (DAPT) in the world. The aim of the study was to conduct comparative description of patient groups with the acid acetilsalicilic (ACS), taken depending on a prescription of clopidogrel or ticagrelor as the second component of DAPT according to data of the year’s work of the Pirogov City Clinical Hospital №1. Materials and methods: clinical data of 854 patients with ACS who undergone treatment in of Pirogov City Clinical Hospital №1 in 2017 were analyzed. Clopidogrel was prescribed to 623 patients (73%) – the I group, ticagrelor 231 (27%) – the II group. Patients in the I group compared to the II group were significantly older (70 and 62 years accordingly), women accounted for 43% in I group and 27% in II group. Arterial hypertension (96 and 89%), diabetes (34 and 26%), post-acute myocardial infarction (38 and 19%), chronic kidney disease (26 and 12%), anemia (15 and 7%). Among patients of II group final diagnosis of ST-elevation myocardial infarction (STEMI) was more often (64 and 31%), coronary angiography (CAG) and percutaneous coronary intervention (PCI) were more frequent – 98/94% and 88/75%, accordingly. Clopidogrel is prescribed to the patients more often in comparison with ticagrelor. Doctors make a choice in favor of clopidogrel for elderly patients, more often women and more comorbid patients. The presence of STEMI, as well as the performance of CAG / PCI in any definitive diagnosis, is associated with a relatively more frequent prescription of ticagrelor, and in elderly patients, the implementation of PCI is the only factor that significantly influences the choice of more active antiaggregant in DAPT.

Keywords

• acute coronary syndrome
• antiplatelet therapy
• clopidogrel
• ticagrelor