In their recent article, Almendro-Delia et al.1 concluded that the association between nonadherence to ticagrelor vs clopidogrel and the risk of major adverse cardiac events (MACE) was not modulated by the choice of P2Y12 receptor inhibitor. Nonetheless, 60 of the 1078 patients on ticagrelor (5.5%) stopped using this drug, while almost twice as many (114/1102 patients, 10.4%) stopped using clopidogrel. In the analysis of factors associated with premature cessation of dual antiplatelet therapy (DAPT), ticagrelor (vs clopidogrel) had an adjusted hazard ratio of 0.97 (95%CI, 0.93-1.01) and a P value of .080, suggesting that the association between nonadherence to DAPT and MACE can in fact be modulated by choice of inhibitor. That said, previous studies have shown an increased risk of bleeding with ticagrelor compared with clopidogrel,2–4 whereas the data presented by Almendro-Delia et al.1 seem to suggest that patients on clopidogrel have a lower risk of DAPT cessation than those on ticagrelor. These findings warrant further discussion and clarification.
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STATEMENT ON THE USE OF ARTIFICIAL INTELLIGENCEArtificial intelligence was not used for this work.
CONFLICTS OF INTERESTNone.