Evaluation of Dual Antiplatelet Therapy in Patients with Myocardial Infarction: Safety and Efficacy Analysis
-
Musarrath Mubeen
Assistant Professor, Department of Pharmacology, Smt. Sarojini Ramulamma College of Pharmacy, (Palamuru University), Seshadri Nagar, Mahabubnagar District, Telangana State, India.
musarrath.mubeen@gmail.com
- Alapati Sathya Sai Guptha Pharm. D Intern, Smt. Sarojini Ramulamma College of Pharmacy, (Palamuru University), Seshadri Nagar, Mahabubnagar District, Telangana State, India.
- Mangali Pallavi Pharm. D Intern, Smt. Sarojini Ramulamma College of Pharmacy, (Palamuru University), Seshadri Nagar, Mahabubnagar District, Telangana State, India.
- Nenavath Pandu Pharm. D, Smt. Sarojini Ramulamma College of Pharmacy, (Palamuru University), Seshadri Nagar, Mahabubnagar District, Telangana State, India
- Fariha Khan Pharm. D, Smt. Sarojini Ramulamma College of Pharmacy, (Palamuru University), Seshadri Nagar, Mahabubnagar District, Telangana State, India
Abstract
Myocardial infarction (MI) is a major cardiovascular emergency associated with myocardial ischemia and necrosis resulting from reduced coronary blood flow. Dual antiplatelet therapy (DAPT), consisting of aspirin combined with a P2Y12 inhibitor, is routinely used to prevent recurrent ischemic events, although bleeding remains an important safety concern. This prospective observational study evaluated the prescribing patterns, efficacy, safety, medication adherence, and adverse drug reactions associated with DAPT among patients with MI. The study was conducted over six months in the Department of Cardiology of a tertiary care teaching hospital and included 100 patients receiving DAPT. Demographic, clinical, treatment, adherence, and adverse drug reaction data were collected using a structured case record form. Medication adherence was assessed using the Morisky Medication Adherence Scale, while adverse drug reactions were evaluated using the WHO–UMC causality assessment scale. The mean patient age was 62.68 ± 10.15 years, 65% were aged above 60 years, and 75% were male. Aspirin plus clopidogrel was the most frequently prescribed regimen (43%), followed by aspirin plus prasugrel (31%) and aspirin plus ticagrelor (26%). Moderate adherence predominated, while adverse drug reactions occurred in 70% of patients, mainly bleeding-related events. Individualized DAPT selection based on thrombotic and bleeding risks may improve safety, adherence, and secondary prevention outcomes following MI.
Downloads
References
2. Mendis S, Puska P, Norrving B. Global Atlas on Cardiovascular Disease Prevention and Control. Geneva: World Health Organization, World Heart Federation and World Stroke Organization; 2011. p. 3–18.
3. Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33(20):2569–2619.
4. O'Connor RE, Brady W, Brooks SC, Diercks D, Egan J, Ghaemmaghami C, et al. Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S787–S817.
5. Coventry LL, Finn J, Bremner AP. Sex differences in symptom presentation in acute myocardial infarction: a systematic review and meta-analysis. Heart Lung. 2011;40(6):477–491.
6. Valensi P, Lorgis L, Cottin Y. Prevalence, incidence, predictive factors and prognosis of silent myocardial infarction: a review of the literature. Arch Cardiovasc Dis. 2011;104(3):178–188.
7. Devlin RJ, Henry JA. Clinical review: major consequences of illicit drug consumption. Crit Care. 2008;12(1):202.
8. Colledge NR, Walker BR, Ralston SH, Davidson LS. Davidson's Principles and Practice of Medicine. 21st ed. Edinburgh: Churchill Livingstone/Elsevier; 2010. p. 588–599.
9. O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. Circulation. 2013;127(4):e362–e425.
10. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial infarction. Circulation. 2012;126(16):2020–2035.
11. Gupta R, Munoz R. Evaluation and management of chest pain in the elderly. Emerg Med Clin North Am. 2016;34(3):523–542.
12. Davis TM, Fortun P, Mulder J, Davis WA, Bruce DG. Silent myocardial infarction and its prognosis in a community-based cohort of Type 2 diabetic patients: the Fremantle Diabetes Study. Diabetologia. 2004;47(3):395–399.
13. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. European Guidelines on cardiovascular disease prevention in clinical practice: version 2012. Eur Heart J. 2012;33(13):1635–1701.
14. Janoudi A, Shamoun FE, Kalavakunta JK, Abela GS. Cholesterol crystal induced arterial inflammation and destabilization of atherosclerotic plaque. Eur Heart J. 2016;37(25):1959–1967.
15. Buja LM. Myocardial ischemia and reperfusion injury. Cardiovasc Pathol. 2005;14(4):170–175.
16. Algranati D, Kassab GS, Lanir Y. Why is the subendocardium more vulnerable to ischemia? A new paradigm. Am J Physiol Heart Circ Physiol. 2011;300(3):H1090–H1100.
17. Cao Z, Chen J, et al. Efficacy and safety of dual antiplatelet therapy de-escalation in East Asian individuals following percutaneous coronary intervention for acute coronary syndrome: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2026.
18. Fitilev SB, Vozzhaev AV. Adherence to dual antiplatelet therapy among outpatients after acute myocardial infarction in primary care. Russian Journal of Pharmacy and Pharmacology. 2019;11:752.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright © Author(s) retain the copyright of this article.
.