OBJECTIVES: Acute coronary syndrome (ACS) is one of the most common cardiovascular causes of death in the UK. It is critical to understand the treatment landscape in the real-world setting. This study evaluated outpatient antiplatelet treatment patterns among UK patients without atrial fibrillation (AF) with a recent ACS event.

METHODS: UK’s Clinical Practice Research Datalink (CPRD) from January 2011 to June 2021 was used for this study. Adult patients with at least one outpatient diagnosis of ACS during the index period were identified, the date of the first ACS diagnosis is the index date. Patients with AF diagnosis or oral anticoagulant use before index ACS date were excluded. ACS subtypes, patient characteristics, treatment type, treatment pattern and duration were evaluated.

RESULTS: The study included 46,827 patients with mean age 67.5 years and 34.2% female. Approximately 42.8% had non-ST-elevation myocardial infarction (NSTEMI), 20.2% had ST-elevation myocardial infarction (STEMI), 7.5% had unstable angina, and 29.4% had unclassified ACS. Almost all (92.9%) patients received antiplatelet medication within 90 days: 62.1% dual antiplatelet therapy (DAPT; aspirin+clopidogrel (33.7%), aspirin+ticagrelor (24.0%), remainder other) and 30.7% single antiplatelet (SAPT; aspirin (17.2%), clopidogrel (9.6%), remainder other). Median antiplatelet treatment duration for overall treated patients was 462 days. The median duration of any antiplatelet therapy was 383, 367, 521, and 481 days for patients who initiated on aspirin, clopidogrel, aspirin+clopidogrel, and aspirin+ticagrelor, respectively. Of patients initiated on aspirin+clopidogrel, 67.1% de-escalated to SAPT within a median of 228 days (54.5% to aspirin, 12.7% to clopidogrel); 69.9% of patients initiated on aspirin+ticagrelor de-escalated to SAPT within a median of 169 days (61.2% to aspirin, 8.7% to ticagrelor).

CONCLUSIONS: Majority of ACS patients received antiplatelet therapy. Further analyses should explore patients’ outcome assessments and any treatment differences between diverse patient subgroups and over time.