@article{discovery10187636, year = {2024}, month = {February}, journal = {Journal of Thrombosis and Thrombolysis}, title = {Remote intensive management to improve antiplatelet adherence in acute myocardial infarction: a secondary analysis of the randomized controlled IMMACULATE trial}, note = {This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.}, publisher = {Springer Science and Business Media LLC}, issn = {0929-5305}, abstract = {This study aim to investigate if remote intensive coaching for the first 6 months post-AMI will improve adherence to the twice-a-day antiplatelet medication, ticagrelor. Between July 8, 2015, to March 29, 2019, AMI patients were randomly assigned to remote intensive management (RIM) or standard care (SC). RIM participants underwent 6 months of weekly then two-weekly consultations to review medication side effects and medication adherence coaching by a centralized nurse practitioner team, whereas SC participants received usual cardiologist face-to-face consultations. Adherence to ticagrelor were determined using pill counting and serial platelet reactivity measurements for 12 months. A total of 149 (49.5\%) of participants were randomized to RIM and 152 (50.5\%) to SC. Adherence to ticagrelor was similar between RIM and SC group at 1 month (94.4 {$\pm$} 0.7\% vs. 93.6{$\pm$}14.7\%, p = 0.537), 6 months (91.0{$\pm$}14.6\% vs. 90.6{$\pm$}14.8\%, p = 0.832) and 12 months (87.4{$\pm$}17.0\% vs. 89.8{$\pm$}12.5\%, p = 0.688). There was also no significant difference in platelet reactivity between the RIM and SC groups at 1 month (251AU*min [212-328] vs. 267AU*min [208-351], p = 0.399), 6 months (239AU*min [165-308] vs. 235AU*min [171-346], p = 0.610) and 12 months (249AU*min [177-432] vs. 259AU*min [182-360], p = 0.678). Sensitivity analysis did not demonstrate any association of ticagrelor adherence with bleeding events and major adverse cardiovascular events. RIM, comprising 6 months of intensive coaching by nurse practitioners, did not improve adherence to the twice-a-day medication ticagrelor compared with SC among patients with AMI. A gradual decline in ticagrelor adherence over 12 months was observed despite 6 months of intensive coaching.}, author = {Sim, HW and Koh, KWL and Poh, SC and Chan, SP and Marchesseau, S and Singh, D and Han, Y and Ng, F and Lim, E and Prabath, JF and Lee, CH and Chen, R and Carvalho, L and Tan, SH and Loh, JPY and Tan, JWC and Kuwelker, K and Amanullah, RM and Chin, CT and Yip, JWL and Lee, CY and Gan, J and Lo, CY and Ho, HH and Hausenloy, DJ and Tai, BC and Richards, AM and Chan, MY}, url = {http://dx.doi.org/10.1007/s11239-023-02931-6} }