After one-month dual antiplatelet therapy (DAPT) with aspirin and ticagrelor, a net clinical benefit was observed when de-escalating to clopidogrel in acute myocardial infarction (AMI) patients treated with PCI.
We have discussed the pros and cons of de-escalating from a potent antiplatelets Such as ticagrelor to clopidogrel since the TOPIC presented at EuroPCR in 2017.
What studies have started to show is something that has been happening in the daily practice. More often because of its cost, but also because of intolerance or bleeding, cardiologists (even patients) change from ticagrelor to clopidogrel.
For the TALOS-AMI the authors included 2697 AMI patients from Korea who had received one-month DAPT with ticagrelor and aspirin with no complications. They were randomized to de-escalating to clopidogrel and aspirin (n=1349) or to continue with ticagrelor and aspirin (n=1348).
Over half were ST elevation MI.
After 2 weeks, there were no deaths or stent thrombosis in the clopidogrel branch.
Read also: ACC 2021 | LAAOS III: Appendage Closure During Central Vascular Surgery.
Primary end point, the combination of cardiovascular death, MI, stroke or BARC 2, 3 or 5 bleeding, resulted below 50% in the clopidogrel branch vs. ticagrelor (4.6% vs 8.2%; HR 0.55; CI 95% 0.40 to 0.76).
This difference was driven by far fewer bleeding events (3.0% vs 5.6%; HR 0.52; CI 95% 0.35 to 0.77) with no differences when observing ischemic events only.
These outcomes were consistent across subgroups, including clinical presentation (with or without ST elevation) sex, age, diabetes, ejection fraction and glomerular filtration.
Original Title: A prospective, multicenter, randomized, open-label trial to compare efficacy and safety of clopidogrel versus ticagrelor in stabilized patients with acute myocardial infarction after percutaneous coronary intervention.
Reference: Chang K et al. Presentado en el congreso de la ACC 2021.
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