Ticagrelor vs Clopidogrel in low risk coronary syndrome

Original Title: Effects of Ticagrelor versus Clopidogrel in Troponin-Negative Patients With Low-Risk ACS Undergoing Ad Hoc PCI. Reference: Dominick J et al. J Am Coll Cardiol. 2016;67(6):603-613.

 

Many patients admitted with low-risk acute coronary syndrome (ACS) are not pre-treated with a P2Y12 receptor inhibitors despite the invasive strategy in place, with angiography and PCI in the same procedure.

No studies assess the pharmacodynamics of ticagrelor vs clopidogrel in “ad hoc” PCI.

The aim of this study was to assess the pharmacodynamics of ticagrelor versus clopidogrel loading dose (LD) in the peri-procedural period among troponin-negative ACS patients undergoing angiography and PCI in the same procedure.

This was a prospective, open and multicenter study in phase IV, where 100 P2Y12 inhibitor naive patients admitted with ACS with negative biomarkers were randomized to 180 mg ticagrelor loading dose vs. 600 mg of clopidogrel loading dose.

Platelet reactivity was measured at baseline, 30 minutes, 2 hours and 8 hours after loading dose and at the end of PCI, with the VerifyNow system. Primary end point was platelet reactivity at 2 hours after loading dose measured in P2Y12 reaction units (PRU); there was also an exploratory analysis on high reactivity rates (PRU >208).

At 2 hours, PRU level was significantly lower in those receiving ticagrelor vs. clopidogrel (98.4 ± 95.4 vs. 257.5 ± 74.5; p < 0.001). PRU levels started to separate at 30 minutes with the most significant difference observed at the end of PCI, and maintained up to 8 hours after loading dose. High platelet reactivity rates also saw a reduction with ticagrelor.

Conclusion
In patients undergoing low risk acute coronary syndrome undergoing ad hoc PCI, ticagrelor offers faster and more powerful platelet inhibition compared to clopidogrel.

More articles by this author

STEACS and the Use of Bivalirudin vs. Heparin: In Search of BRIGHT-4 Outcomes

Various studies and registries have previously shown the impact of post-percutaneous coronary intervention (PCI) complications on the survival of patients with ST-segment elevation acute...

TAVR and Atrial Fibrillation: What Anticoagulants Should We Use?

The prevalence of atrial fibrillation (AF) in TAVR patients ranges from 15 to 30%, depending on series. This arrhythmia has been associated to higher...

Ultrathin vs Thin-Strut Stents in PCI Patients at High Bleeding Risk

Several in vivo studies have shown that ultrathin stents present lower thrombogenic risk vs. thin-strut stents, which reflects in lower rates of target lesion...

Should We Withdraw Anticoagulation Before TAVR?

Approximately one-third of patients undergoing transcatheter aortic valve replacement (TAVR) have atrial fibrillation and are on oral anticoagulant (OAC) therapy. This creates a complex...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....