Ferlini M, et al. - Researchers explored what factors determined clopidogrel use in the population of the multicenter prospective Acute Coronary Syndrome and Diabetes Registry carried out during a 9-week period between March and May 2015 at 29 Hospitals. Clopidogrel was found to be the most used P2Y12 inhibitor at hospital discharge in the high-risk population of this registry. This corroborated the “paradox" to treat sicker patients with the less effective drug. No impact of diabetic status, a marker of higher thrombotic risk, was evident on this choice; however, bleeding risk was considered.

Methods

• This study included in the registry 559 consecutive acute coronary syndrome patients [mean age: 68.7±11.3 years, 50% ST-elevation myocardial infarction (STEMI)] with “known DM” (56%) or “hyperglycemia” at admission; 460 (85%) patients received a myocardial revascularization.

Results

• At hospital discharge, 88% of the patients received a prescription for dual antiplatelet therapy (39% clopidogrel, 38% ticagrelor, and 23% prasugrel).
• Based on history of diabetes, age, and clinical presentation (unstable angina/non-STEMI vs non-STEMI), differences in P2Y12 inhibitor administration were recorded.
• Univariate analysis revealed a significant association of following factors with clopidogrel choice at discharge: age older than 75 years or more, known DM, peripheral artery disease, previous myocardial infarction, previous revascularization, complete revascularization, previous cerebrovascular event, creatinine clearance, unstable angina/non-STEMI at presentation, Global Registry of Acute Coronary Events Score, EuroSCORE, CRUSADE Bleeding Score, and oral anticoagulant therapy.
• Only oral anticoagulant therapy and the CRUSADE Bleeding Score were noted to be independent predictors of clopidogrel prescription in multivariate analysis.