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Comparative Effectiveness and Safety of P2Y12 Inhibitors in the Secondary Prophylaxis of Acute Coronary Syndrome- [electronic resource]
Comparative Effectiveness and Safety of P2Y12 Inhibitors in the Secondary Prophylaxis of Acute Coronary Syndrome- [electronic resource]
상세정보
- 자료유형
- 학위논문파일 국외
- 최종처리일시
- 20240214095846
- ISBN
- 9798380123372
- DDC
- 615
- 저자명
- Kumar, Arun.
- 서명/저자
- Comparative Effectiveness and Safety of P2Y12 Inhibitors in the Secondary Prophylaxis of Acute Coronary Syndrome - [electronic resource]
- 발행사항
- [S.l.]: : University of Minnesota., 2021
- 발행사항
- Ann Arbor : : ProQuest Dissertations & Theses,, 2021
- 형태사항
- 1 online resource(266 p.)
- 주기사항
- Source: Dissertations Abstracts International, Volume: 85-02, Section: B.
- 주기사항
- Advisor: Farley, Joel F.
- 학위논문주기
- Thesis (Ph.D.)--University of Minnesota, 2021.
- 사용제한주기
- This item must not be sold to any third party vendors.
- 초록/해제
- 요약One of the major problems among patients suffering from coronary heart disease especially acute coronary syndrome (ACS) is recurrent cardiovascular events following revascularization. Therefore, treatment with P2Y12 receptor antagonists and aspirin, widely known as dual antiplatelet therapy (DAPT), is strongly recommended as secondary prophylaxis following revascularization. DAPT has been shown to be effective at reducing recurrent events and rehospitalization. However, it has also been shown to increase the risk of major bleeding events. Clopidogrel, a P2Y12 inhibitor, has been utilized for ACS management since its approval in 1997 with two additional P2Y12 agents approved by the US Food and Drug Administration in 2009 (prasugrel) and 2011 (ticagrelor). Compared with clopidogrel these newer agents have more potent and predictable antiplatelet aggregation profiles, attributed to consistent pharmacokinetics and dynamics. However, the evidence related to their safety and efficacy/effectiveness is inconsistent. Moreover, the evidence from the studies conducted in the US comes from electronic health records that may not be generalizable to a broader US population. In this dissertation, we sought to assess the comparative effectiveness and safety of different P2Y12 inhibitors in patients with ACS following revascularization with percutaneous coronary intervention (PCI) using commercial claims and encounters (CCAE) and Medicare Supplement (MDCR) data samples of the MarketScan database that may represent a broader US populationIn the first aim of this dissertation, we looked at the treatment patterns of different P2Y12 inhibitors among patients with coronary heart disease. Recommendations for antiplatelet treatment with P2Y12 agents after revascularization vary across types of revascularization i.e., fibrinolysis, PCI, or coronary artery bypass grafting, and across different clinical characteristics. Aim 1 examined patterns of P2Y12 inhibitor utilization across a number of important characteristics including high bleeding risk, history of stroke/trans-ischemic attack, and associated comorbidities. Our results show that in the year 2018, ticagrelor became the most prescribed drug among patients below age 65 years compared to clopidogrel and prasugrel. We also observed an increased utilization of ticagrelor among patients managed with PCI. However, regardless of age, clopidogrel was the most commonly used drug in patients revascularized using coronary artery bypass graft. Clopidogrel use was more common than other P2Y12 inhibitors in patients with higher comorbid indices, a history of stroke/trans ischemic attacks, and in patients with a high risk of bleeding.In the second and third aims, we assessed the effectiveness and safety of different P2Y12 inhibitors among ACS patients undergoing PCI respectively. Our results showed no difference in the primary effectiveness outcome, defined as any cardiovascular event at 30 days and 180 days observation between propensity score (PS) matched treatment cohorts in our combined CCAE and MDCR population. However, in the MDCR sample, we saw an 84% higher risk of hospitalization due to composite cardiovascular outcome in the female population associated with prasugrel compared to ticagrelor in 180 days outcome using a time to event analysis with Cox-regression hazard models. Additionally, in the CCAE sample, those who were managed with bare-metal stents (BMS) stent had a 43% lower risk of hospitalization due to composite cardiovascular outcome when prescribed prasugrel compared to ticagrelor at 180 days. We did not find any difference in hospitalizations due to composite major bleeding identified using the Cunningham algorithm in all of the PS matched comparisons across all the groups. However, we found a significant 44% increased risk of hospitalization because of major bleeding with prasugrel compared to ticagrelor at 180 days.This study provides useful information related to coronary heart disease management and insight into how newer agents are being utilized in a real-world US population. We show a significant increase in the use of ticagrelor in younger populations undergoing a PCI. Multiple predictors of P2Y12 inhibitor use were studied. Although antiplatelet prescription guidelines were generally followed, the use of prasugrel among patients with a history of stroke or transient ischemic attack was also observed which is contraindicated and may be worth additional investigation. Differences in the use of P2Y12 inhibitors across different patient clinical characteristics may have important policy implications and help to guide appropriate prescribing. Additionally, we observed that the female population benefited more from newer P2Y12 use in our study. Given the differential mechanism of sex on ACS prognosis, future studies are warranted to confirm this finding.
- 일반주제명
- Pharmaceutical sciences.
- 일반주제명
- Pharmacology.
- 일반주제명
- Health sciences.
- 일반주제명
- Health care management.
- 키워드
- Effectiveness
- 키워드
- P2Y12 inhibitors
- 키워드
- Safety
- 기타저자
- University of Minnesota Social and Administrative Pharmacy
- 기본자료저록
- Dissertations Abstracts International. 85-02B.
- 기본자료저록
- Dissertation Abstract International
- 전자적 위치 및 접속
- 로그인 후 원문을 볼 수 있습니다.
MARC
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■020 ▼a9798380123372
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■040 ▼aMiAaPQ▼cMiAaPQ
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■1001 ▼aKumar, Arun.
■24510▼aComparative Effectiveness and Safety of P2Y12 Inhibitors in the Secondary Prophylaxis of Acute Coronary Syndrome▼h[electronic resource]
■260 ▼a[S.l.]:▼bUniversity of Minnesota. ▼c2021
■260 1▼aAnn Arbor :▼bProQuest Dissertations & Theses, ▼c2021
■300 ▼a1 online resource(266 p.)
■500 ▼aSource: Dissertations Abstracts International, Volume: 85-02, Section: B.
■500 ▼aAdvisor: Farley, Joel F.
■5021 ▼aThesis (Ph.D.)--University of Minnesota, 2021.
■506 ▼aThis item must not be sold to any third party vendors.
■520 ▼aOne of the major problems among patients suffering from coronary heart disease especially acute coronary syndrome (ACS) is recurrent cardiovascular events following revascularization. Therefore, treatment with P2Y12 receptor antagonists and aspirin, widely known as dual antiplatelet therapy (DAPT), is strongly recommended as secondary prophylaxis following revascularization. DAPT has been shown to be effective at reducing recurrent events and rehospitalization. However, it has also been shown to increase the risk of major bleeding events. Clopidogrel, a P2Y12 inhibitor, has been utilized for ACS management since its approval in 1997 with two additional P2Y12 agents approved by the US Food and Drug Administration in 2009 (prasugrel) and 2011 (ticagrelor). Compared with clopidogrel these newer agents have more potent and predictable antiplatelet aggregation profiles, attributed to consistent pharmacokinetics and dynamics. However, the evidence related to their safety and efficacy/effectiveness is inconsistent. Moreover, the evidence from the studies conducted in the US comes from electronic health records that may not be generalizable to a broader US population. In this dissertation, we sought to assess the comparative effectiveness and safety of different P2Y12 inhibitors in patients with ACS following revascularization with percutaneous coronary intervention (PCI) using commercial claims and encounters (CCAE) and Medicare Supplement (MDCR) data samples of the MarketScan database that may represent a broader US populationIn the first aim of this dissertation, we looked at the treatment patterns of different P2Y12 inhibitors among patients with coronary heart disease. Recommendations for antiplatelet treatment with P2Y12 agents after revascularization vary across types of revascularization i.e., fibrinolysis, PCI, or coronary artery bypass grafting, and across different clinical characteristics. Aim 1 examined patterns of P2Y12 inhibitor utilization across a number of important characteristics including high bleeding risk, history of stroke/trans-ischemic attack, and associated comorbidities. Our results show that in the year 2018, ticagrelor became the most prescribed drug among patients below age 65 years compared to clopidogrel and prasugrel. We also observed an increased utilization of ticagrelor among patients managed with PCI. However, regardless of age, clopidogrel was the most commonly used drug in patients revascularized using coronary artery bypass graft. Clopidogrel use was more common than other P2Y12 inhibitors in patients with higher comorbid indices, a history of stroke/trans ischemic attacks, and in patients with a high risk of bleeding.In the second and third aims, we assessed the effectiveness and safety of different P2Y12 inhibitors among ACS patients undergoing PCI respectively. Our results showed no difference in the primary effectiveness outcome, defined as any cardiovascular event at 30 days and 180 days observation between propensity score (PS) matched treatment cohorts in our combined CCAE and MDCR population. However, in the MDCR sample, we saw an 84% higher risk of hospitalization due to composite cardiovascular outcome in the female population associated with prasugrel compared to ticagrelor in 180 days outcome using a time to event analysis with Cox-regression hazard models. Additionally, in the CCAE sample, those who were managed with bare-metal stents (BMS) stent had a 43% lower risk of hospitalization due to composite cardiovascular outcome when prescribed prasugrel compared to ticagrelor at 180 days. We did not find any difference in hospitalizations due to composite major bleeding identified using the Cunningham algorithm in all of the PS matched comparisons across all the groups. However, we found a significant 44% increased risk of hospitalization because of major bleeding with prasugrel compared to ticagrelor at 180 days.This study provides useful information related to coronary heart disease management and insight into how newer agents are being utilized in a real-world US population. We show a significant increase in the use of ticagrelor in younger populations undergoing a PCI. Multiple predictors of P2Y12 inhibitor use were studied. Although antiplatelet prescription guidelines were generally followed, the use of prasugrel among patients with a history of stroke or transient ischemic attack was also observed which is contraindicated and may be worth additional investigation. Differences in the use of P2Y12 inhibitors across different patient clinical characteristics may have important policy implications and help to guide appropriate prescribing. Additionally, we observed that the female population benefited more from newer P2Y12 use in our study. Given the differential mechanism of sex on ACS prognosis, future studies are warranted to confirm this finding.
■590 ▼aSchool code: 0130.
■650 4▼aPharmaceutical sciences.
■650 4▼aPharmacology.
■650 4▼aHealth sciences.
■650 4▼aHealth care management.
■653 ▼aAcute coronary syndrome
■653 ▼aEffectiveness
■653 ▼aP2Y12 inhibitors
■653 ▼aPercutaneous coronary intervention
■653 ▼aSafety
■653 ▼aSecondary prophylaxis
■690 ▼a0572
■690 ▼a0566
■690 ▼a0419
■690 ▼a0769
■71020▼aUniversity of Minnesota▼bSocial and Administrative Pharmacy.
■7730 ▼tDissertations Abstracts International▼g85-02B.
■773 ▼tDissertation Abstract International
■790 ▼a0130
■791 ▼aPh.D.
■792 ▼a2021
■793 ▼aEnglish
■85640▼uhttp://www.riss.kr/pdu/ddodLink.do?id=T16930977▼nKERIS▼z이 자료의 원문은 한국교육학술정보원에서 제공합니다.
■980 ▼a202402▼f2024
