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Southern Saskatchewan Ticagrelor Registry experience

Authors Dehghani P, Chopra V, Bell A, Kelly S, Zulyniak L, Booker J, Zimmermann R, Semchuk W, Cheema AN, Lavoie AJ

Received 26 May 2014

Accepted for publication 2 July 2014

Published 16 October 2014 Volume 2014:8 Pages 1427—1435

DOI https://doi.org/10.2147/PPA.S68423

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Payam Dehghani,1 Varun Chopra,1 Ali Bell,2 Sheila Kelly,1 Lori Zulyniak,2 Jeff Booker,1 Rodney Zimmermann,1 William Semchuk,2 Asim N Cheema,3 Andrea J Lavoie1

1Prairie Vascular Research Network, University of Saskatchewan, Regina, SK, 2Regina Qu’Appelle Health Region, Regina, SK, 3St Michael’s Hospital, University of Toronto, Toronto, ON, Canada

Background: As ticagrelor enters into clinical use for acute coronary syndrome, it is ­important to understand patient/physician behavior in terms of appropriate use, adherence, and event rates.
Methods: The Saskatchewan Registry is a prospective, observational, multicenter cohort study that identifies consecutive patients started on ticagrelor. We aimed to evaluate both on- and off-label use, identify characteristics of patients who prematurely stop ticagrelor, and describe patient/physician behavior contributing to inappropriate stoppage of this medication.
Results: From April 2012 to September 2013, 227 patients were initiated on ticagrelor, with a mean age of 62.2±12.1 years. The participants were 66% men and had a mean follow up of 157.4±111.7 days. Seventy-four patients (32.4%) had off-label indications. Forty-seven patients (20.7%) prematurely stopped ticagrelor and were more likely to be older, women, nonwhite, present with shock, and complain of dyspnea. Twenty-six of the 47 patients stopped ticagrelor inappropriately because of patient nonadherence (18 patients) and physician advice (eight patients). A composite outcome event of death from vascular causes, myocardial infarction, or stroke occurred in 8.8% of the entire cohort and was more likely to occur in those older then 65 years, those presenting with cardiogenic shock, and those who prematurely stopped ticagrelor.
Conclusion: In this real-world registry of patients started on ticagrelor, a third have off-label indications and a fifth prematurely stop the medication. Premature discontinuation was an independent predictor of major life-threatening bleeding and increased composite event rate of death from vascular causes, myocardial infarction, or stroke.

Keywords: ticagrelor, acute coronary syndrome, registry, adherence, compliance, antiplatelets

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