Translation. Region: Russian Federal
Source: Peoples'Friendship University of Russia –
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Researchers from the RUDN Medical Institute and Moscow City Polyclinic No. 2 analyzed how patients after acute myocardial infarction comply with recommendations for taking dual antiplatelet therapy (DAPT) — a combination of acetylsalicylic acid (ASA) and a P2Y12 inhibitor (ticagrelor, clopidogrel or prasugrel). The work was awarded first place in the Competition of scientific works of young scientists in the field of drug safety "LekBez 2025" at the III Russian Congress "Pharmacotherapy Safety 360°: Noli nocere!"
The study included 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 relationship between adherence, bleeding complications of therapy and the risk of recurrent cardiovascular events.
After myocardial infarction, DAPT is critical to prevent recurrent infarctions. However, according to the study results, 43.5% of patients stopped adhering to the therapy regimen in the second half of the year, despite preferential provision of drugs in Moscow. 24.4% of patients experienced hemorrhagic complications (bleeding), which forced them to independently adjust or stop treatment. An additional problem was the rare use of the PRECISE-DAPT scale by doctors to predict bleeding, although this risk was high in 22.6% of patients when assessed in the study. These circumstances lead to a dilemma: refusal of DAPT reduces the number of bleedings, but increases the risk of recurrent infarctions. For example, non-adherent patients were hospitalized due to cardiac complications in the second half of the year more than three times more often than those who continued therapy.
“Solving this problem requires a comprehensive approach. First of all, it is necessary to implement treatment adherence monitoring by recording electronic prescriptions. This will allow doctors to track the patient’s compliance with therapy in real time and promptly adjust prescriptions. In addition, an individual approach to therapy adjustment is necessary. For example, in case 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 with a high risk of bleeding according to the PRECISE-DAPT scale, international recommendations provide for a reduction in the duration of DAPT to 3-6 months. It is equally important to implement continuous education among both patients and healthcare professionals. Patients need to be explained the risks associated with interrupting therapy, and doctors need to be informed about the importance of using modern bleeding risk assessment scales to prescribe the correct personalized treatment,” says Dmitry Klyuev, assistant professor at the Department of General and Clinical Pharmacology, RUDN Medical Institute.
The study was conducted by a research team from RUDN University. Among the co-authors:
Sergey Fitilev, Professor of the Department of General and Clinical Pharmacology; Irina Shkrebneva, Associate Professor of the Department of General and Clinical Pharmacology; Alexander Vozzhaev, Professor of the Department of General and Clinical Pharmacology; Anna Ovaeva, Assistant of the Department of General and Clinical Pharmacology.
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