<h2 class="section-title">Abstract</h2> <div id="as0005"> <h3 id="st0010">Background/purpose</h3> <p id="sp0040">Dual <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/antiplatelet" title="Learn more about Antiplatelet">antiplatelet</a> <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/combination-therapy" title="Learn more about Combination Therapy">therapy</a> (DAPT) varies after placement of <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/drug-eluting-stent" title="Learn more about Drug-Eluting Stent">drug-eluting stents</a> (DES) in patients presenting with <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/acute-coronary-syndrome" title="Learn more about Acute Coronary Syndrome">acute coronary syndromes</a> (ACS). Our aim was to study patient characteristics and predictors of switching, in-hospital or at discharge, from <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/clopidogrel" title="Learn more about Clopidogrel">clopidogrel</a> (CLO) to <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/ticagrelor" title="Learn more about Ticagrelor">ticagrelor</a>(TIC) or vice versa.</p> </div> <div id="as0010"> <h3 id="st0015">Methods/materials</h3> <p id="sp0045">The <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/population-research" title="Learn more about Population Research">study population</a> included patients with ACS who had DES and initially received either CLO or TIC between January 2011 and December 2017. Patients were divided into 4 groups based on initial DAPT choice and whether DAPT was switched in-hospital or during discharge. Clinical outcomes of interest were bleeding events, need for <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/anticoagulation" title="Learn more about Anticoagulation">anticoagulation</a>, and need for in-hospital <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/coronary-artery-bypass-graft" title="Learn more about Coronary Artery Bypass Graft">coronary artery bypass graft</a> (CABG).</p> </div> <div id="as0015"> <h3 id="st0020">Results</h3> <p id="sp0050">We identified 2837 patients who received DES and started on DAPT. DAPT switch from 1 <a href="https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/p2y12" title="Learn more about P2Y12">P2Y12</a> inhibitor to another occurred in 9%, either in-hospital or at discharge. Of 1834 patients started on CLO, <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/3-4-amino-1-1-dimethylbutyl-6-1-hydroxyethyl-oxapenem-3-carboxylic-acid" title="Learn more about 3 (4 Amino 1,1 Dimethylbutyl) 6 (1 Hydroxyethyl)oxapenem 3 Carboxylic Acid">112 were</a> switched to TIC. Of 1003 patients started on TIC, 142 were switched to CLO. The need for in-hospital CABG was 7.8% in the TIC-CLO group compared to none in the CLO-TIC group (p = 0.002). Adjusted for covariates, the TIC-CLO group was 3 times more likely to need anticoagulation with <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/warfarin" title="Learn more about Warfarin">warfarin</a> than the CLO-CLO group (p < 0.001) and over 5 times more likely than the CLO-TIC group and the TIC-TIC group (p < 0.005 for both).</p> </div> <div id="as0020"> <h3 id="st0025">Conclusions</h3> <p id="sp0055">Switching from 1 generation P2Y12 inhibitor to another does occur in ACS patients. Clinical needs such as in-hospital CABG or oral anticoagulation upon discharge are real and dictate the switch from TIC to CLO.</p> </div> <div id="as0025"> <h3 id="st0030">Summary</h3> <p id="sp0060">A single-center observational study of 2837 patients with acute coronary syndromes treated with drug-eluting stents found that some do get switched from one generation P2Y12 inhibitor to another. The switch from clopidogrel to ticagrelor is driven by clinical needs such as in-hospital coronary artery bypass grafting or the need for oral anticoagulation upon discharge.</p> </div>