Events that happened in our study were few

Events that happened in our study were few. of death, recurrent myocardial infarctions, re-intervention, and major bleeding. We studied 321 patients (54 female patients, 16.82%). The mean age of the patients was 56.65??11.01?years. Ticagrelor was stopped in 76.7% on follow-up. It was stopped in 6.3%, 13.5%, 13.1%, 21.9%, and 45.1% of patients during the first month but after discharge, between first and third months, between 3 and 6?months, between 6 and 12?months, and after 12?months, respectively. In the majority of patients, ticagrelor was replaced by clopidogrel (97.9%). It was stopped according to the physicians discretion in 79.3% of patients, whereas it was the cost of the drug that made the patient to get swapped to another agent in 18.6%. No difference in the primary composite outcome was observed between the groups where ticagrelor was continued post 12? months and ticagrelor was continued and ticagrelor was switched-over to another agent. Similarly, no difference in death, recurrent myocardial infarctions, re-interventions, or major bleeding manifestations was observed between the two groups. Conclusion In patients with acute coronary syndrome who undergo PCI, we observed that early discontinuation of ticagrelor and switching over to other P2Y12 inhibitors after discharge did not affect clinical outcomes. test. Categorical variables were analyzed by chi-squared test. A value ?55% in 57.9%. Mild LV dysfunction (LVEF45C55%), moderate LV dysfunction (30C45%), and severe LV dysfunction ( n n% n n%

Diabetes741.213044.50.79Acute coronary syndrome groupUSA741.211840.40.99NSTEMI211.83512.0STEMI847.113947.6Ejection fractionEF??30%00.082.70.8EF??55%1164.7517058.2EF-30C45%317.65518.8EF-45C55%317.65920.2Culprit vesselLeft anterior descending artery (LAD)741.216054.80.32Circumflex (LCX)211.854916.8Right coronary artery (RCA)847.17826.7Left main or triple vessel disease00.051.7Reason for stopping0.70Ticagrelor – not stooped635.66722.9Ticagrelor stopped – physician-based decision15.9114.7Ticagrelor stopped – cost1058.817861.0Ticagrelor stopped – non-availability of drug00.031.0Ticagrelor stopped – side effects00.010.3Nature of drug that was used during switch-over from ticagrelorTicagrelor continued635.36722.90.45Clopidogrel1164.721975.0Prasugrel00.062.1Timing of ticagrelor stopped and eventNot stopped635.36622.6Stopped ?12?months317.610435.6 Open in a separate window Discussion In this real-world single-center experience study, we observed early discontinuation of ticagrelor after discharge, and switching-over to other P2Y12 agents in patients with acute coronary syndrome did not affect clinical outcomes. It was found that ticagrelor was stopped early, i.e., before the end of the first year in the majority of Epiberberine patients. It happened more frequently after 6?months post Epiberberine PCI. Though the cost of ticagrelor remained an important factor in the discontinuation of the drug, it was stopped at the discretion of the physician in the majority of patients. Newer oral P2Y12 receptor blockers like ticagrelor and prasugrel have been shown to have increased bleeding risk as compared to clopidogrel [2, 3]. Similar to the PLATO trial, a large prospective registry from Sweden has shown better outcomes with ticagrelor as compared to clopidogrel [4]. Though few case reports from India attributed increased risk of bleeding to newer Epiberberine antiplatelet agents like ticagrelor [5], large observational studies have documented the safety of ticagrelor and prasugrel in the Indian subset of patients [6C8]. Similar to the other two studies from India, we observed ticagrelor to be safe in Indian patients. Major societal guidelines recommend continuing ticagrelor at least 12?months post-acute coronary syndrome interventions [9C11] Igf1 based on the PLATO trial. In contrary to the above findings, the CHANGE-DAPT study has shown that ticagrelor was associated with increased events.