OBJECTIVES

Secondary prophylaxis is essential to reduce the adverse cardiovascular outcomes post revascularization in coronary heart disease (CHD). P2Y12 inhibitors (i.e. clopidogrel, prasugrel, or ticagrelor) are effective for this purpose; however, guidelines for which P2Y12 inhibitor to prescribe differ according to the patient’s clinical characteristics, and trends in their utilization is not well studied in the real-world setting. The objective of this study is to determine trends in the prescription patterns of P2Y12 inhibitors in CHD patients.

METHODS

We utilized a retrospective cohort study design using the MarketScan Commercial Claims Database (2013-2018). We included CHD patients prescribed P2Y12 inhibitors within 14 days of index revascularization to compare the utilization of newer P2Y12 inhibitors (i.e. ticagrelor, prasugrel) with clopidogrel. In longitudinal cross-sectional trend analyses, we performed the Cochrane-Armitage test to see if there was a significant change (at p=0.05) in the trend between three months' prevalence of these agents from the year 2013 to 2018.

RESULTS

Among 92,734 identified patients, we observed a continuous decreased utilization of clopidogrel from 65.5% in the year 2013 to 43.9% in 2018; whereas ticagrelor use increased from 13.6% to 45.6%, which replaced clopidogrel as the most prescribed medication in 2018. In high bleeding risk, although decreasing, clopidogrel (50.6%) remained the most prescribed medication in 2018; however, ticagrelor utilization increased from 12.0% in 2013 to 40.1% in 2018. Additionally, clopidogrel (77.8%) was the preferred medication among patients with stroke history. Importantly, prasugrel continued to lose the market-share with time. We found a significant change in the trend of the prescription for all the P2Y12 inhibitors with time at p=0.05.

CONCLUSIONS

Ticagrelor use increased over the years in our data sample which exceeded the market share of clopidogrel in 2018. In most of the cases, we observed that the American Heart Association guidelines were well reflected in the clinical practice.