Publication:

Real-world practice perspectives of Indian clinicians on dual antiplatelet therapy optimization post percutaneous coronary intervention and utilization of aspirin clopidogrel fixed dose combination in secondary prevention: INDI PROLONG STUDY

Background Background: Dual antiplatelet therapy (DAPT) is post-percutaneous coronary intervention (PCI) to prevent thrombotic events. However, optimal duration and agent choice remain debated, particularly in Indian practice. This study explored real-world clinician perspectives on DAPT optimization and the use of aspirin–clopidogrel fixed-dose combinations (FDCs).

Methods The INDI-PROLONG study was an anonymous, cross-sectional PAN India survey conducted between June 15 and August 15, 2024. A total of 301 clinicians, including cardiologists, consulting physicians, diabetologists, and other specialists, participated. The survey assessed DAPT prescription patterns, preferred regimens, determinants of duration, and perceptions of aspirin–clopidogrel FDCs.

Results Of 301 clinicians, 259 (86.1%) routinely prescribed DAPT post-PCI. For high thrombotic risk patients, 165 (54.8%) favored >12 months of therapy, while 136 (45.2%) recommended 12 months. Clopidogrel + aspirin was most preferred (57.8%), followed by ticagrelor + aspirin (23.9%) and prasugrel + aspirin (15.6%). Clopidogrel was prescribed to 25–50% of eligible patients by 137 (45.5%) clinicians. Key factors influencing duration included bleeding risk (48.8%), guideline recommendations (39.5%), adherence (36.5%), and thrombotic risk (32.2%). Switching from ticagrelor to clopidogrel was mainly due to bleeding (56.5%) and adverse reactions (30.6%). Cardiologists favored prolonged therapy, while consulting physicians preferred standard 12-month durations. Regional variation was noted, with northern India showing a higher preference for extended DAPT.

Conclusion Indian clinicians demonstrate varied DAPT strategies, balancing efficacy, safety, and accessibility. Clopidogrel + aspirin remains the dominant choice. Findings highlight the need for India-specific guidelines to optimize DAPT duration and agent selection based on real-world evidence.