Real-World Bleeding and Ischemic Events in Asian Patients on P2Y12-Inhibitors After Percutaneous Coronary Intervention: A National Claims Data Analysis

Introduction The safety and effectiveness of potent P2Y12 inhibitors in East Asians have been questioned because of the higher bleeding tendency and lower thrombotic risk in this population. We comparatively evaluated the safety, effectiveness and treatment persistence of the dual antiplatelet therapies (DAPT) with clopidogrel (CDAPT), ticagrelor (TDAPT) and prasugrel (PDAPT) after percutaneous coronary intervention (PCI) in the Korean population. Methods A retrospective cohort study was conducted using Korean National Health Insurance claims data. In 57,197 patients treated with DAPT after PCI, the risk of bleeding events, risk of major adverse cardiac and cerebral events (MACCE: a composite of all-cause death, myocardial infarction [MI], stroke and revascularization), risk of net adverse clinical events (NACE) and persistence and adherence rates were assessed with stabilized inverse probability of treatment weighting. Results TDAPT was associated with higher risks of bleeding (1 year: hazard ratio [HR], 1.37; 95% confidence interval [CI] 1.28-1.46; prolonged: HR 1.39, 95% CI 1.31-1.47), MACCE (1 year: HR 1.10, 95% CI 1.03-1.18; prolonged: HR 1.24, 95% CI 1.16-1.31) and NACE (1 year: HR 1.23, 95% CI 1.18-1.29; prolonged: HR 1.31, 95% CI 1.25-1.36) than CDAPT both at 1 year and in the prolonged periods, whereas there were no significant differences between PDAPT and CDAPT. Similar results were also observed in a subgroup analysis of patients with baseline MI. CDAPT was associated with higher persistence and adherence rates than TDAPT and PDAPT. Conclusions CDAPT was associated with clinical outcomes that were more favorable than those in TDAPT and comparable to those in PDAPT and drug persistence and adherence that were higher than in TDAPT or PDAPT. Clopidogrel may remain a viable first option for post-PCI DAPT in East Asian patients with a low thrombotic risk and a high bleeding tendency.

Automated summary

In this study, the safety, effectiveness, and treatment persistence of DAPT with clopidogrel, ticagrelor, and prasugrel were compared after PCI in the Korean population. Ticagrelor was associated with higher risk of bleeding, MACCE, and NACE compared to clopidogrel, whereas no significant differences were found between prasugrel and clopidogrel. Clopidogrel showed higher persistence and adherence rates in patients after PCI.