Publication:

Evaluation of cardiovascular events and bleeding complications in patients of Acute Coronary Syndrome on various antiplatelet drugs: an observational study in a tertiary care center in Eastern India

Background This study is to determine the clinical profile of Acute Coronary Syndrome (ACS) patients, to observe cardiovascular events in patients with ACS undergoing Percutaneous Coronary Intervention (PCI) and to evaluate the bleeding complications with various antiplatelet agents.

Methods This hospital based observational study included patients of ACS presenting between February 2015 to August 2016 who received PCI and were on dual antiplatelet agents.

Results Among 200 patients presenting with ACS mean age was 58.67, there was male predominance and 52.5% presented with STEMI. Cardiovascular death was seen in 2.5% patients and all cause mortality was seen in 3.5% patients. The incidence of Non-fatal myocardial infarction was more in Clopidogrel group (5%) as compared to Prasugrel (4%) and Ticagrelor (2%) group. Non-fatal stroke was seen in 2% patients and incidence was similar in each of the three groups. Incidences of target vessel revascularization (TVR) and stent thrombosis were more in the Clopidogrel group as compared to Prasugrel and Ticagrelor. TIMI Major and Minor bleeding with Prasugrel was higher than clopidogrel and Ticagrelor and TIMI minimal bleeding was seen in 2% patients and was similar in all three groups.

Conclusions Patients receiving clopidogrel has more numbers of CV death, all cause death, non-fatal MI, TVR and stent thrombosis in comparison to the groups receiving Prasugrel or Ticagrelor and on comparing Prasugrel and Ticagrelor, the two drugs are similar in efficacy but, Ticagrelor has better safety outcomes.