After a heart attack, 44% of patients quit treatment, risking another attack – study by RUDN University scientists
The study covered 168 patients who demonstrated high adherence to dual antiplatelet therapy in the first 6 months after myocardial infarction and assessed how their behavior changed over the course of a year, as well as the correlation between adherence, haemorrhagic complications of therapy and the risk of recurrent cardiovascular events.
After a myocardial infarction, DAPT is critical for preventing recurrent heart attacks. However, according to the study results, 43.5% of patients stopped adhering to their treatment regimen in the second half of the year, despite subsidized medication in Moscow. 24.4% of patients experienced hemorrhagic complications (bleeding), which forced them to adjust or discontinue treatment on their own. An additional problem was the rare use of the PRECISE-DAPT scale by doctors to predict bleeding, although in 22.6% of patients this risk was found to be high in the study assessment. These circumstances lead to a dilemma: discontinuing DAPT reduces the number of bleeds but increases the risk of recurrent heart attacks. For example, in non-adherent patients, hospitalizations due to cardiac complications in the second half of the year were more than three times more frequent than in those who continued therapy.
“Solving this problem requires a comprehensive approach. First and foremost, it is necessary to implement monitoring of treatment adherence through the use of electronic prescriptions. This will allow doctors to track the degree of patient compliance with therapy in real time and adjust prescriptions in a timely manner. In addition, an individual approach to therapy adjustment is necessary. For example, in cases of mild bleeding, it is advisable to temporarily reduce the dose of acetylsalicylic acid (19.5% of cases) or replace ticagrelor with clopidogrel (9.8%). For patients at high risk of bleeding according to the PRECISE-DAPT scale, international guidelines recommend reducing the duration of DAPT to 3–6 months. Implementing continuous education among both patients and healthcare professionals is equally important. Patients need to be informed about the risks associated with discontinuing therapy, and physicians need to be informed about the importance of using modern bleeding risk assessment scales to prescribe the right personalized treatment,” Dmitry Klyuev, assistant professor in the Department of General and Clinical Pharmacology at the RUDN University Institute of Medicine.
The study was conducted by a research team at RUDN University. Co-authors include:
- Sergey Fitilov, Professor, Department of General and Clinical Pharmacology;
- Irina Shkrebneva, Associate Professor, Department of General and Clinical Pharmacology;
- Alexander Vozzhaev, Professor, Department of General and Clinical Pharmacology;
- Anna Ovaeva, Assistant, Department of General and Clinical Pharmacology.
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Ten scientific journals published by RUDN University have been included in the highest level of the state list of scientific publications, the White List.
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