Treatment switches in the ACS and STEMI-only populations by intervention group (AC and AT) and by type of switch and whether the switch occurred before or after a bleeding or ischaemic event
| Type of switch | Median (IQR) time to switch (months) | Bleed occurred | Ischaemic event* occurred | No ischaemic or bleeding events | ||||
| Before switch* | After switch | Before switch (within 2 months) | Before switch | After switch | ||||
| ACS | ||||||||
| AC | Discontinued Asp 300/2769 (11%) | 8.0 (5.6, 10.9) | 19 (6%) | 8 (3%) | 5 (2%) | 19 (6%) | 6 (2%) | 251 (84%) |
| Discontinued C 124/2769 (4%) | 8.0 (5.9, 10.2) | 8 (6%) | 2 (2%) | 3 (2%) | 12 (10%) | 2 (2%) | 102 (82%) | |
| Discontinued AC 84/2769 (3%) | 7.9 (5.5, 9.9) | 5 (6%) | 2 (2%) | 3 (4%) | 8 (10%) | 4 (5%) | 66 (79%) | |
| Initiated a different P2Y12 inhibitor 52/2769 (2%) | 2.0 (1.0, 3.8) | 2 (4%) | 4 (8%) | 11 (21%) | 11 (21%) | 3 (6%) | 34 (65%) | |
| AT | Discontinued Asp 210/1920 (11%) | 8.0 (6.0, 10.3) | 22 (10%) | 2 (1%) | 1 (1%) | 8 (4%) | 3 (1%) | 177 (84%) |
| Discontinued T 154/1920 (8%) | 8.1 (6.3, 10.3) | 12 (8%) | 4 (3%) | 2 (1%) | 8 (5%) | 3 (2%) | 129 (84%) | |
| Discontinued AT 85/1920 (4%) | 7.6 (6.1, 9.7) | 7 (8%) | 3 (4%) | 2 (2%) | 5 (6%) | 2 (2%) | 69 (81%) | |
| Initiated a different P2Y12 inhibitor 151/1920 (8%) | 3.3 (1.9, 6.0) | 11 (7%) | 7 (5%) | 2 (1%) | 4 (3%) | 2 (1%) | 128 (85%) | |
| STEMI | ||||||||
| AC | Discontinued Asp 114/1023 (11%) | 7.9 (5.6, 11.2) | 11 (10%) | 0 | 1 (1%) | 6 (5%) | 2 (2%) | 96 (84%) |
| Discontinued C 43/1023 (4%) | 7.9 (6.4, 9.5) | 7 (16%) | 0 | 1 (2%) | 6 (14%) | 0/43 | 32 (74%) | |
| Discontinued AC 30/1023 (3%) | 7.2 (5.1, 9.1) | 5 (17%) | 0 | 1 (3%) | 3 (10%) | 1 (3%) | 22 (73%) | |
| Initiated a different P2Y12 inhibitor 18/1023 (2%) | 1.2 (0.8, 3.1) | 2 (11%) | 1 (6%) | 2 (11%) | 2 (11%) | 1 (6%) | 13 (72%) | |
| AP | Discontinued Asp 38/406 (9%) | 8.7 (6.4, 10.9) | 4 (11%) | 0 | 1 (3%) | 1 (3%) | 1 (3%) | 32 (84%) |
| Discontinued P 16/406 (4%) | 9.9 (7.9, 11.6) | 2 (13%) | 0 | 1 (6%) | 2 (13%) | 0 | 12 (75%) | |
| Discontinued AP 14/406 (3%) | 8.8 (6.3, 11.3) | 1 (7%) | 0 | 1 (7%) | 1 (7%) | 1 (7%) | 11 (80%) | |
| Initiated a different P2Y12 inhibitor 22/406 (5%) | 2.9 (1.5, 4.6) | 1 (5%) | 0 | 0 | 0 | 0 | 21 (95%) | |
| AT | Discontinued Asp 128/1158 (11%) | 7.7 (5.9, 9.9) | 16 (13%) | 2 (2%) | 1 (1%) | 5 (4%) | 3 (2%) | 103 (80%) |
| Discontinued P 92/1158 (8%) | 7.8 (6.0, 9.6) | 7 (8%) | 3 (3%) | 2 (2%) | 5 (5%) | 3 (3%) | 74 (80%) | |
| Discontinued AP 50/1158 (4%) | 7.2 (6.1, 8.7) | 5 (10%) | 2 (4%) | 2 (4%) | 3 (6%) | 2 (4%) | 38 (76%) | |
| Initiated a different P2Y12 inhibitor 84/1158 (7%) | 3.3 (1.7, 6.8) | 8 (10%) | 5 (6%) | 0 | 1 (1%) | 2 (2%) | 68 (76%) | |
Follow-up was censored at time of first bleed; therefore, any patients who switched because of a bleed were not included in the analysis after the switch.
*MI or stroke. NB: ‘After switch’ includes switches on the same day as the event; for those who discontinued aspirin and clopidogrel, the earliest date of cessation was used.
AC, aspirin and clopidogrel; ACS, acute coronary syndrome; AP, aspirin and prasugrel; Asp, aspirin; AT, aspirin and ticagrelor; STEMI, ST-elevation myocardial infarction.