Introduction:
The CHARISMA trial for chronic cardiovascular disease (CVD) and the ACTIVE-W trial for atrial fibrillation (AF) demonstrated benefits of dual antiplatelet therapy with aspirin and clopidogrel (A+C) versus aspirin alone. We hypothesized that these trials caused increased prescription of A+C in clinical practice.
Methods:
We queried the ACC's PINNACLE Program for patients meeting inclusion criteria of the CHARISMA trial (CVD defined as CAD, angina, stroke/TIA, or PVD; excluded AF or PCI patients) or the ACTIVE-W trial (chronic AF, not prescribed warfarin). We determined the proportion of patients prescribed A+C therapy by quarter 9/08-12/09. A Poisson model was established for A+C prescription by patient-quarter.
Results:
We identified 80,583 patients meeting CHARISMA criteria and 20,245 patients meeting ACTIVE-W criteria. Prescription of A+C therapy for CVD patients meeting CHARISMA criteria increased during the study period from 15.3% to 25.1% (p<0.001). Prescription of A+C therapy for AF patients meeting ACTIVE-W criteria increased from 3.0% to 4.0% (p=0.029). In both groups, most of the increase occurred after Q2 2009, when ACTIVE-W was published. In the Poisson model, after adjustment for age, sex, and insurance status, the increased prescription rate ratios were 1.0736 (1.0644-1.0829, p<0.0001) for CVD patients and 1.0390 (0.9927-1.0875, p=0.1001) for AF patients; after separate adjustment for comorbidities, the rate ratios were 1.0811 (1.0719-1.0903, p<0.0001) and 1.0747 (1.0238-1.1232, p=0.0014) respectively.
Conclusion:
Following CHARISMA and ACTIVE-W, clinicians have increased prescription of AsC therapy for patients with CVD or AF.
DUAL ANTIPLATELET THERAPY IN THE REAL CLINICAL PRACTICE
