Novel antiplatelet agents, like ticagrelor and prasugrel, have been developed in response to evidence that there are a subgroup of patients who are less responsive to clopidogrel and may predispose patients to recurrent ischaemic events and higher mortality in the setting of an acute coronary syndrome.1,2 We report on a retrospective observational study assessing the experience and compliance of patients commenced on ticagrelor in the Midlands region.133 patients were identified and interviewed for the purpose of the study. 69% were male with a mean patient age of 67. 10% identified as New Zealand Mori. 53% were Non-ST-segment elevation MI (NSTEMI) and 97% were on aspirin in addition to ticagrelor. Two-thirds (67%) were treated with percutaneous revascularisation and 20% with medical therapy. The remainder were elective patients commenced on ticagrelor post angioplasty.42% (56/133) of patients had completed the 12 month duration of dual-antiplatelet therapy at the time of the telephone interview and 30% (40/133) were still taking ticagrelor. Self-reported compliance was excellent, with 97 % (129/133) reporting missing a dose less than once a month, or not at all. Overall satisfaction with ticagrelor treatment was positive. 65% (87/133) of patients reported satisfaction with ticagrelor. 8% (10/133) were ambivalent. Patients who had previous experience with clopidogrel expressed a preference for this agent.Premature discontinuation of ticagrelor occurred in 25% (34/133) of patients, primarily due to dyspnoea 56% (19/34). Bleeding was responsible for stopping ticagrelor in 9% (3/34) of discontinuations.This real world experience in discontinuation rates may in part be explained by inexperience in managing patients with dyspnoea on ticagrelor. These patients often present in primary care and other causes of dyspnoea, which include heart failure and bronchospasm need to be carefully excluded before concluding a likely relationship with ticagrelor.3 On-going education of both patients and practitioners is essential in the management of anticipated side effects to ensure patients are not denied potential benefit, which includes a reduction in cardiovascular mortality with this agent.

Novel antiplatelet agents, like ticagrelor and prasugrel, have been developed in response to evidence that there are a subgroup of patients who are less responsive to clopidogrel and may predispose patients to recurrent ischaemic events and higher mortality in the setting of an acute coronary syndrome.1,2 We report on a retrospective observational study assessing the experience and compliance of patients commenced on ticagrelor in the Midlands region.133 patients were identified and interviewed for the purpose of the study. 69% were male with a mean patient age of 67. 10% identified as New Zealand Mori. 53% were Non-ST-segment elevation MI (NSTEMI) and 97% were on aspirin in addition to ticagrelor. Two-thirds (67%) were treated with percutaneous revascularisation and 20% with medical therapy. The remainder were elective patients commenced on ticagrelor post angioplasty.42% (56/133) of patients had completed the 12 month duration of dual-antiplatelet therapy at the time of the telephone interview and 30% (40/133) were still taking ticagrelor. Self-reported compliance was excellent, with 97 % (129/133) reporting missing a dose less than once a month, or not at all. Overall satisfaction with ticagrelor treatment was positive. 65% (87/133) of patients reported satisfaction with ticagrelor. 8% (10/133) were ambivalent. Patients who had previous experience with clopidogrel expressed a preference for this agent.Premature discontinuation of ticagrelor occurred in 25% (34/133) of patients, primarily due to dyspnoea 56% (19/34). Bleeding was responsible for stopping ticagrelor in 9% (3/34) of discontinuations.This real world experience in discontinuation rates may in part be explained by inexperience in managing patients with dyspnoea on ticagrelor. These patients often present in primary care and other causes of dyspnoea, which include heart failure and bronchospasm need to be carefully excluded before concluding a likely relationship with ticagrelor.3 On-going education of both patients and practitioners is essential in the management of anticipated side effects to ensure patients are not denied potential benefit, which includes a reduction in cardiovascular mortality with this agent.