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The impact of switching P2Y12 receptor inhibitor therapy during index hospitalization: a systematic review

  • Pharmacoepidemiology and Prescription
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Abstract

Purpose

With the availability of novel P2Y12 receptor inhibitors, patients presenting with acute coronary syndrome (ACS) may receive more than one type of this drug during index hospitalization. We sought to determine the effect of switching from clopidogrel to a novel P2Y12 receptor inhibitor on the occurrence of major adverse cardiovascular events (MACE) and bleeding.

Methods

We conducted a literature search on SCOPUS for English language entries until 7 March 2015. Out of 188 citations, seven studies encompassing 16,431 patients were selected for analysis of (i) switching to a novel P2Y12 agent (switching group) versus continued clopidogrel or (ii) switching to a novel P2Y12 agent (switching group) versus upfront novel agent initiation during index hospitalization

Results

MACE was significantly lower in the switching group (odds ratio (OR) 0.77, 95 % confidence interval (CI) 0.63–0.96, p = 0.02), whereas bleeding was higher (OR 1.55, 1.29–1.85, p < 0.01) compared with continued clopidogrel. Conversely, MACE was similar with switching to a novel agent and upfront novel therapy initiation (OR 1.01, 95 % CI 0.8–1.29, p = 0.90), but bleeding was higher in the switching group (OR 1.24, 95 % CI 1.03–1.48, p = 0.02).

Conclusions

The current study suggests that switching to a novel P2Y12 agent in patients with ACS and/or patients undergoing coronary stenting is more efficacious than continuing clopidogrel. In this cohort, switching to a novel agent did not result in worse ischemic outcomes than upfront initiation of novel therapies. However, switching was associated with greater bleeding compared with both continued clopidogrel as well as upfront use of novel P2Y12 agents.

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Author notes

    Authors and Affiliations

    1. Division of Cardiology, University of Ottawa Heart Institute, CAPITAL Research Group, Ottawa, Ontario, Canada

      Jaya Chandrasekhar, Benjamin Hibbert, Michael Froeschl, Derek So, Roxana Mehran & Michel Le May

    2. Icahn School of Medicine at Mount Sinai, PO Box 1030, 1 Gustave L Levy place, New York, NY, 10029, USA

      Jaya Chandrasekhar

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    1. Jaya Chandrasekhar
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    2. Benjamin Hibbert
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    3. Michael Froeschl
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    on behalf of the CAPITAL investigators

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    Correspondence to Jaya Chandrasekhar.

    Additional information

    Jaya Chandrasekhar and Benjamin Hibbert contributed equally to this work.

    Electronic supplementary material

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    Supplemental Table 1

    Quality of studies using the Newcastle Ottawa Quality Assessment Scale (DOC 34 kb)

    Supplemental Table 2

    Study Definitions (DOCX 19 kb)

    Supplemental Table 3

    Data on switching and anti-P2Y12 therapies in the included studies (DOCX 16 kb)

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    Chandrasekhar, J., Hibbert, B., Froeschl, M. et al. The impact of switching P2Y12 receptor inhibitor therapy during index hospitalization: a systematic review. Eur J Clin Pharmacol 72, 83–91 (2016). https://doi.org/10.1007/s00228-015-1949-1

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