Pragmatic Use of Ticagrelor: ImprovingOutcomes in Medical Management of Acute Coronary Syndrome (PracTiCal India Study)
Journal of Indian College of Cardiology ():10.4103/jicc.jicc_73_24, June 05, 2025. | DOI: 10.4103/jicc.jicc_73_24
Abstract
Background:
The utilization of ticagrelor in the medical management ofacute coronary syndrome (ACS) has been extensively explored in interventions such as percutaneous coronary intervention. However, its use in acute coronarysyndrome without intervention remains inadequately explored. The PracTiCal India Study was initiated to address this gap, aiming to optimize ticagrelor’s application in medical management in treating various cardiovascularconditions, particularly acute coronary syndrome.
Methods:
This questionnaire-based survey was conducted amongcardiologists in India. The questionnaire consisted of eight questions specifically designed to collect data on the most effective and efficient methods for managing acute coronary syndrome, with a focus on the optimal utilization of ticagrelor. The survey results were subsequently discussed in a round table meeting by a panel of experts.
Results:
A total of 103 cardiologists completed the survey. Among theparticipants, 70.9% preferred ticagrelor for not reperfused ST-segment elevation myocardial infarction (STEMI) and 58.3% of participants chose it for nonrevascularized non-STEMI (NSTEMI). The participants commonly consideredmultiple stents (76.7%), a high risk of stent thrombosis (74.8%), and a history of previous revascularization (63.1%) as the most significant factors for initiating ticagrelor. The most common factors limiting the effective use of ticagrelor were bleeding risk (63.1%) and cost (52.4%). In addition, 43.7%preferred transitioning ACS patients to ticagrelor without reperfusion after using a different P2Y12 inhibitor.
Conclusion:
The study highlights ticagrelor as the preferred P2Y12inhibitor for both not reperfused STEMI and NSTEMI cases, reflecting its widespread acceptance among cardiologists. The decision to employ ticagrelor is primarily influenced by stent-related complications and the patient’s comorbidity profile. However, the practical application of ticagrelor is often hindered by concerns regarding hemorrhagic complications and the cost of therapy, particularly in scenarios involving patients who have not undergonerevascularization procedures.
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