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Switching From Ticagrelor or Prasugrel to Clopidogrel
James J Nawarskas1, Tiffany N Montoya1
1From the University of New Mexico College of Pharmacy and University of New Mexico Hospitals, Albuquerque, NM.
Cardiology in Review
|December 8, 2017
Summary
Switching patients from ticagrelor or prasugrel to clopidogrel may reduce bleeding risk and costs. While this switch reduces antiplatelet efficacy, current data suggest it may be acceptable for patients unable to adhere to newer therapies.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Ticagrelor and prasugrel offer greater efficacy than clopidogrel but incur higher costs and bleeding risks.
- Patient adherence to long-term P2Y12 inhibitor therapy can be challenging due to cost and bleeding concerns.
Purpose of the Study:
- To evaluate the clinical implications of switching patients from ticagrelor or prasugrel to clopidogrel.
- To assess whether reduced antiplatelet efficacy affects clinical outcomes in this switch scenario.
Main Methods:
- Review of existing clinical trial data investigating the switch from newer P2Y12 inhibitors to clopidogrel.
- Analysis of pharmacodynamic effects and clinical outcomes associated with the switch.
Main Results:
- Current clinical trial data have not demonstrated significant clinical detriment from switching patients.
- Limitations exist in current investigations, necessitating caution regarding large-scale switches.
Conclusions:
- Switching patients unable to adhere to ticagrelor or prasugrel to clopidogrel appears reasonable for maintaining platelet aggregation suppression.
- While not recommended for large-scale implementation, this strategy may minimize ischemic event risk in select patient populations.
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