OPINE-IT: Oral Antiplatelets Usage Pattern in Acute Coronary Syndrome: Exploring the Indian Ticagrelor Experience

Abstract

Background: Dual anti-platelet therapy (DAPT) includes aspirin and a P2Y12-receptor antagonist, is the cornerstone of treatment for patients with acute coronary syndrome (ACS). Real-world data on the perception and belief on the use of oral anti-platelets (OAP) for the management of ACS can provide vital information about any existent gaps between clinical practice and evidence based medicine and can help effectively address the ways to improve patient care management. Aims and Objectives: The purpose was to record the responses from the real-world practice amongst Indian cardiologists on the uses of OAPs to manage ACS. Materials and Methods: The present survey was a prospective observational survey on a set of 16 questions, of which response was collected from 192 clinicians [Cardiologists (majorly), cardio-vascular thoracic surgeons and physicians]. Results: A high prevalence of ACS was noted by the clinician each month. The majority of the patients reached the emergency room (ER) of a hospital between 2-4 hours (57.2%) after the onset of symptoms. ST-segment elevation myocardial infarction (STEMI) accounted for 42.4% of all patients. The major factors deciding the choice of OAP amongst clinicians were faster onset of action of the drug (84.2%), followed by lesser bleeding risk (47.3%). Overall, ticagrelor was the most preferred P2Y12 antagonist (92%) in this real-world practice survey; the perceived reasons being primarily due to its faster onset and offset of action (85.2%). The high cost was the major factor for not considering ticagrelor (63%). The majority of the participants found ticagrelor treatment (65%) to be safe, as per lesser bleeding experience in clinical practice. Conclusion: In this pan-India survey, ticagrelor was found to be the drug of choice among Indian Cardiologists due to multiple benefits for ACS management in real-world practice.