Are We Optimizing the Use of Dual Antiplatelet Therapy in Patients Hospitalized with Acute Myocardial Infarction?

Autor: Darleen M. Lessard, Robert J. Goldberg, Essa Hariri, Joel M. Gore, Jeffrey J. Rade
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
Time Factors
animal structures
Prasugrel
medicine.medical_treatment
Myocardial Infarction
030204 cardiovascular system & hematology
Drug Prescriptions
Risk Assessment
Article
03 medical and health sciences
Coronary artery bypass surgery
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Humans
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Healthcare Disparities
Practice Patterns
Physicians'
Aged
Cardiac catheterization
Aged
80 and over
Aspirin
business.industry
Dual Anti-Platelet Therapy
General Medicine
Odds ratio
Middle Aged
medicine.disease
Clopidogrel
Drug Utilization
Hospitalization
Treatment Outcome
Massachusetts
Conventional PCI
Purinergic P2Y Receptor Antagonists
Female
Cardiology and Cardiovascular Medicine
business
Prasugrel Hydrochloride
Platelet Aggregation Inhibitors
medicine.drug
Zdroj: Cardiovasc Revasc Med
ISSN: 1553-8389
Popis: Background Dual antiplatelet therapy (DAPT) is a mainstay treatment for hospital survivors of an acute myocardial infarction (AMI). However, there are limited data on the prescribing patterns of DAPT among patients hospitalized with AMI during recent years. Objective To examine decade-long trends (2001−2011) in the use of DAPT versus antiplatelet monotherapy and patient characteristics associated with DAPT use. Methods The study population consisted of 2389 adults hospitalized with an initial AMI at all 11 central Massachusetts medical centers on a biennial basis between 2001 and 2011. DAPT was defined as the discharge use of aspirin plus either clopidogrel or prasugrel. Logistic regression analysis was used to identify patient characteristics associated with DAPT use. Results The average age of the study population was 65 years, and 69% of patients were discharged on DAPT. The use of DAPT at the time of hospital discharge increased from 49% in 2001 to 74% in 2011; this increasing trend was seen across all age groups, both sexes, types of AMI, and in those who underwent a PCI. After multivariable adjustment, patients 65–74 years old (adjusted odds ratio (aOR) = 0.53, 95% CI: 0.36–0.80) and those who underwent coronary artery bypass surgery (aOR = 0.11, 95% CI: 0.07–0.18) were less likely to have received DAPT, while men (aOR = 14.60, 95% CI: 10.66–19.98) and those who underwent cardiac catheterization and stenting (aOR = 14.60, 95% CI: 10.66–19.98) were significantly more likely to have received DAPT at discharge than respective comparison groups. Conclusions Between 2001 and 2011, the use of DAPT increased markedly among patients hospitalized with AMI. However, a significant proportion of patients were not discharged on this therapy. Greater awareness is needed to incorporate DAPT into the management of patients hospitalized with AMI.
Databáze: OpenAIRE
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