Analysis of pharmacotherapy practice in patients after myocardial infarction: results of a prospective open study «PROMETHEUS»

According to the guidelines of the Russian Society of Cardiology, dual antiplatelet therapy (DAPT) is a standard treatment regimen for the prevention of cardiovascular events in patients after myocardial infarction (MI). However, some deviations from standard treatment regimens can be noted when conducting pharmacoepidemiological studies of DAPT, in real clinical practice. Aim : To analyse dual antiplatelet and antithrombotic therapy in patients after myocardial infarction in the Kaliningrad region at the outpatient stage of medical care. Material and Methods . Analysis of drug therapy in 130 patients after MI was performed in five different study periods (visit 1-5). Visit 1 corresponded to the moment of patients’ discharge from hospital, and visits 2–5 were conducted at 1, 3, 6 and 12 months after hospitalization for myocardial infarction. Results . It was found that 97.7% of patients were prescribed dual antiplatelet therapy after hospitalisation, but the frequency of DAPT use gradually decreased during the year, reaching 67.7% in 360 days after MI. However, some deviations from standard treatment regimens were observed: 13.3% of patients received acetylsalicylic acid (ASA) monotherapy, 6.7% of patients received clopidogrel only, 5.7% of patients received ticagrelor only, and 6.7% of patients did not receive antiplatelet therapy. The most common combination used for DAPT in all study periods was the combination of acetylsalicylic acid and ticagrelor (59.4–67.6%). Some deviations in the choice of antithrombotic therapy were also revealed: 2 patients received ticagrelor as a part of triple antithrombotic therapy. At the same time, the duration of triple antithrombotic therapy for the combination of acetylsalicylic acid + ticagrelor + rivaroxaban was 1 year with the optimal duration from 1 to 6 months for patients with high risk of stroke, and for patients with high risk of bleeding this period may be limited by the period of patient hospitalisation. Conclusion . In the Kaliningrad region, the majority of patients (from 67.7 to 97.7%) after MI receive DAPT at different times of medical care, but after a year, significant deviations from standard therapy regimens were observed. Deviations were also revealed when analysing the use of antithrombotic therapy: the use of ticagrelor as part of triple antithrombotic therapy, as well as an increase in its duration. These changes indicate the necessity to identify and analyse these deviations.