Contemporary use of prasugrel in clinical practice: Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Amneet Sandhu, Milan Seth, Simon Dixon, David Share, David Wohns, Thomas LaLonde, Mauro Moscucci, Arthur L. Riba, Michael Grossman, Hitinder S. Gurm

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background-Prasugrel is a recently approved thienopyridine for use in patients with acute coronary syndromes undergoing percutaneous coronary intervention. There are no data on contemporary use of prasugrel in routine clinical practice. Methods and Results-We assessed the patterns of prasugrel use among 55 821 patients who underwent percutaneous coronary intervention and were discharged alive from January 2010 to December 2011 at 44 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Potential inappropriate therapy was defined as use in patients who had a history of cerebrovascular disease, weighed <60 kg, or were aged ≥75 years old. Clopidogrel was prescribed to 83% (n=46 574) and 17% (n=9247) of patients received prasugrel on hospital discharge. A steady, linear increase in prasugrel use was seen during the study period, with discharge prescription increasing from 8.4% in quarter 1 of 2010 to 22.3% in quarter 4 of 2011. Of the total cohort, 69.1% of patients presented with acute coronary syndrome, and in this group, 17.2% received prasugrel. Among patients prescribed prasugrel, 28.3% (n=2614) received the medication for indications outside of acute coronary syndromes. One or more known contraindications to the drug were present in 6% to 10% of patients discharged on this agent. Conclusions-There has been a steady increase in the use of prasugrel with the drug being used in =22% of patients undergoing percutaneous coronary intervention by study end. Prasugrel use in patients with known contraindications is not uncommon and may be a suitable target for focused quality improvement efforts.

Original languageEnglish
Pages (from-to)293-298
Number of pages6
JournalCirculation: Cardiovascular Quality and Outcomes
Volume6
Issue number3
DOIs
StatePublished - May 1 2013

Fingerprint

Blue Cross Blue Shield Insurance Plans
Percutaneous Coronary Intervention
Acute Coronary Syndrome
clopidogrel
Prasugrel Hydrochloride
Cerebrovascular Disorders
Quality Improvement
Pharmaceutical Preparations
Prescriptions

Keywords

  • Acute coronary syndromes
  • Coronary revascularization
  • Stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Contemporary use of prasugrel in clinical practice : Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. / Sandhu, Amneet; Seth, Milan; Dixon, Simon; Share, David; Wohns, David; LaLonde, Thomas; Moscucci, Mauro; Riba, Arthur L.; Grossman, Michael; Gurm, Hitinder S.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 6, No. 3, 01.05.2013, p. 293-298.

Research output: Contribution to journalArticle

Sandhu, Amneet ; Seth, Milan ; Dixon, Simon ; Share, David ; Wohns, David ; LaLonde, Thomas ; Moscucci, Mauro ; Riba, Arthur L. ; Grossman, Michael ; Gurm, Hitinder S. / Contemporary use of prasugrel in clinical practice : Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. In: Circulation: Cardiovascular Quality and Outcomes. 2013 ; Vol. 6, No. 3. pp. 293-298.
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T1 - Contemporary use of prasugrel in clinical practice

T2 - Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

AU - Sandhu, Amneet

AU - Seth, Milan

AU - Dixon, Simon

AU - Share, David

AU - Wohns, David

AU - LaLonde, Thomas

AU - Moscucci, Mauro

AU - Riba, Arthur L.

AU - Grossman, Michael

AU - Gurm, Hitinder S.

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N2 - Background-Prasugrel is a recently approved thienopyridine for use in patients with acute coronary syndromes undergoing percutaneous coronary intervention. There are no data on contemporary use of prasugrel in routine clinical practice. Methods and Results-We assessed the patterns of prasugrel use among 55 821 patients who underwent percutaneous coronary intervention and were discharged alive from January 2010 to December 2011 at 44 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Potential inappropriate therapy was defined as use in patients who had a history of cerebrovascular disease, weighed <60 kg, or were aged ≥75 years old. Clopidogrel was prescribed to 83% (n=46 574) and 17% (n=9247) of patients received prasugrel on hospital discharge. A steady, linear increase in prasugrel use was seen during the study period, with discharge prescription increasing from 8.4% in quarter 1 of 2010 to 22.3% in quarter 4 of 2011. Of the total cohort, 69.1% of patients presented with acute coronary syndrome, and in this group, 17.2% received prasugrel. Among patients prescribed prasugrel, 28.3% (n=2614) received the medication for indications outside of acute coronary syndromes. One or more known contraindications to the drug were present in 6% to 10% of patients discharged on this agent. Conclusions-There has been a steady increase in the use of prasugrel with the drug being used in =22% of patients undergoing percutaneous coronary intervention by study end. Prasugrel use in patients with known contraindications is not uncommon and may be a suitable target for focused quality improvement efforts.

AB - Background-Prasugrel is a recently approved thienopyridine for use in patients with acute coronary syndromes undergoing percutaneous coronary intervention. There are no data on contemporary use of prasugrel in routine clinical practice. Methods and Results-We assessed the patterns of prasugrel use among 55 821 patients who underwent percutaneous coronary intervention and were discharged alive from January 2010 to December 2011 at 44 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Potential inappropriate therapy was defined as use in patients who had a history of cerebrovascular disease, weighed <60 kg, or were aged ≥75 years old. Clopidogrel was prescribed to 83% (n=46 574) and 17% (n=9247) of patients received prasugrel on hospital discharge. A steady, linear increase in prasugrel use was seen during the study period, with discharge prescription increasing from 8.4% in quarter 1 of 2010 to 22.3% in quarter 4 of 2011. Of the total cohort, 69.1% of patients presented with acute coronary syndrome, and in this group, 17.2% received prasugrel. Among patients prescribed prasugrel, 28.3% (n=2614) received the medication for indications outside of acute coronary syndromes. One or more known contraindications to the drug were present in 6% to 10% of patients discharged on this agent. Conclusions-There has been a steady increase in the use of prasugrel with the drug being used in =22% of patients undergoing percutaneous coronary intervention by study end. Prasugrel use in patients with known contraindications is not uncommon and may be a suitable target for focused quality improvement efforts.

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KW - Coronary revascularization

KW - Stents

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