Published: 2017-10-25

Evaluation of cardiovascular events and bleeding complications in patients of Acute Coronary Syndrome on various antiplatelet drugs: an observational study in a tertiary care center in Eastern India

Anurag Passi, Prashant Kumar, Somnath Mukherjee, Priyanker Mondal, Sankar Chandra Mandal


Background: This study is to determine the clinical profile of Acute Coronary Syndrome (ACS) patients, to observe cardiovascular events in patients with ACS undergoing Percutaneous Coronary Intervention (PCI) and to evaluate the bleeding complications with various antiplatelet agents.

Methods: This hospital based observational study included patients of ACS presenting between February 2015 to August 2016 who received PCI and were on dual antiplatelet agents.

Results: Among 200 patients presenting with ACS mean age was 58.67, there was male predominance and 52.5% presented with STEMI. Cardiovascular death was seen in 2.5% patients and all cause mortality was seen in 3.5% patients. The incidence of Non-fatal myocardial infarction was more in Clopidogrel group (5%) as compared to Prasugrel (4%) and Ticagrelor (2%) group. Non-fatal stroke was seen in 2% patients and incidence was similar in each of the three groups. Incidences of target vessel revascularization (TVR) and stent thrombosis were more in the Clopidogrel group as compared to Prasugrel and Ticagrelor. TIMI Major and Minor bleeding with Prasugrel was higher than clopidogrel and Ticagrelor and TIMI minimal bleeding was seen in 2% patients and was similar in all three groups.

Conclusions: Patients receiving clopidogrel has more numbers of CV death, all cause death, non-fatal MI, TVR and stent thrombosis in comparison to the groups receiving Prasugrel or Ticagrelor and on comparing Prasugrel and Ticagrelor, the two drugs are similar in efficacy but, Ticagrelor has better safety outcomes.


Acute Coronary Syndrome, Antiplatelet drugs, Percutaneous coronary intervention

Full Text:



Yeghiazarians Y, Braunstein JB, Askari A, Stone PH. Unstable angina pectoris. N Engl J Med. 2000;342:101-14.

Antiplatelet Trialists' Collaboration. Collaborative overview of randomized trials of antiplatelet therapy. I. Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ. 1994;308:81-106.

Low-molecular-weight heparin during instability in coronary artery disease. Lancet. 1996;347:561-8.

Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Circulation. 2004;110:e82-292.

Sugidachi A, Asai F, Ogawa T, Inoue T, Koike H. The in vivo pharmacological profile of CS-747, a novel antiplatelet agent with platelet ADP receptor antagonist properties. Br J Pharmacol. 2000;129:1439-46.

Gurbel PA, Bliden KP, Butler K, Tantry US, Gesheff T, Wei C, et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET study. Circulation. 2009;120:2577-85.

Brandt JT, Payne CD, Wiviott SD, Weerakkody G, Farid NA, Small DS, et al. A comparison of prasugrel and clopidogrel loading doses on platelet function: magnitude of platelet inhibition is related to active metabolite formation. Am Heart J. 2007;153:66:e9-16.

Wiviott SD, Trenk D, Frelinger AL, O'Donoghue M, Neumann FJ, Michelson AD, et al. Prasugrel compared with high loading- and maintenance-dose clopidogrel in patients with planned percutaneous coronary intervention: the Prasugrel in Comparison to Clopidogrel for Inhibition of Platelet Activation and Aggregation-Thrombolysis in Myocardial Infarction 44 trial. Circulation. 2007;116:2923-32.

Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, Reddy KS, et al. Treatment and outcomes of acute coronary syndromes in India (CREATE): A prospective analysis of registry data. Lancet. 2008;371:1435-42.

Gupta R, Gupta VP. Meta-analysis of coronary heart disease prevalence in India. Indian Heart J. 1996;48:241-5.

Sharma R, Bhairappa S, Prasad SR, Manjunath CN. Clinical characteristics, angiographic profile and in hospital mortality in acute coronary syndrome patients in south indian population Year. 2014;2(3):65-9.

Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. Lancet. 2004;364:937-52.

Hasdai D, Behar S, Wallentin L. A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin; the Euro Heart Survey of Acute Coronary Syndromes (Euro Heart Survey ACS). Eur Heart J. 2002;23:1190-201.

Mandelzweig L, Battler A, Boyko V, Bueno H, Danchin N, Filippatos G, et al. The second Euro Heart Survey on acute coronary syndromes: characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. European heart Journal. 2006 Aug 14;27(19):2285-93.

Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006 Nov 23;333(7578):1091.

Budaj A, Brieger D, Steg PG, Goodman SG, Dabbous OH, Fox KA, et al. Global patterns of use of antithrombotic and antiplatelet therapies in patients with acute coronary syndromes: insights from the Global Registry of Acute Coronary Events (GRACE). American Heart J. 2003 Dec 31;146(6):999-1006.

Fox KA, Goodman SG, Klein W, Brieger D, Steg PG, Dabbous O, et al. Management of acute coronary syndromes. Variations in practice and outcome. Findings from the Global Registry of Acute Coronary Events (GRACE). European Heart J. 2002 Aug 1;23(15):1177-89.

Farmer JA, Gotto AM. Dyslipidemia and other risk factors for coronary heart disease.In Braunwald E, editor. Heart Disease: A textbook of Cardiovascular Medicine. 5th edition. Philadelphia: WB Saunders; 1997:1126-1160.

Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357:2001-15.

Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. New England Journal of Medicine. 2009 Sep 10;361(11):1045-57.

Yadav P, Joseph D, Joshi P, Sakhi P, Jha RK, Gupta J. Clinical profile & risk factors in acute coronary syndrome. National J Comm Med. 2010;1(2):150-1.

Motovska Z, Hlinomaz O, Miklik R, Hromadka M, Varvarovsky I, Dusek J, et al. Prasugrel Versus Ticagrelor in Patients with Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention. Circulation. 2016 Nov 22;134(21):1603-12.

Alexopoulos D, Xanthopoulou I, Deftereos S, Hamilos M, Sitafidis G, Kanakakis I, et al. Contemporary antiplatelet treatment in acute coronary syndrome patients undergoing percutaneous coronary intervention: 1‐year outcomes from the GReek AntiPlatElet (GRAPE) Registry. J of Thro and Hae. 2016 Jun 1;14(6):1146-54.