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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 A, Lavoie A

Received 26 May 2014

Accepted for publication 2 July 2014

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


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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