Evaluation of a Novel Antiplatelet Therapy Strategy in Patients Undergoing Elective Percutaneous Coronary...

Area of Science:

• Cardiology
• Pharmacology

Background:

• Ticagrelor offers lower thrombotic risk than clopidogrel in acute coronary syndromes.
• Its use in dual antiplatelet therapy-naive patients with stable ischemic heart disease undergoing elective percutaneous intervention is not well-defined.
• Uncertainty exists regarding optimal conversion to clopidogrel to avoid bleeding.

Purpose of the Study:

• To evaluate the safety and efficacy of initiating ticagrelor and subsequently transitioning to clopidogrel in patients with stable ischemic heart disease undergoing elective percutaneous intervention.

Main Methods:

• Retrospective cohort review of patients with stable ischemic heart disease undergoing elective percutaneous intervention.
• The 'Switch Rx' group received ticagrelor pre-PCI, transitioned to clopidogrel 300 mg post-PCI, and were discharged on clopidogrel 75 mg daily.
• The 'Standard Rx' group received clopidogrel loading and daily maintenance, serving as a matched comparator cohort.
• Safety outcomes included bleeding events at 24 hours and 30 days.
• Efficacy outcomes included major adverse cardiac events at 24 hours and 30 days.

Main Results:

• Five 'Switch Rx' patients (n=54) experienced minor bleeding (ARC type I) within 24 hours, with no further bleeding up to 30 days.
• In a matched comparison (n=39 each), no major adverse cardiac events occurred within 30 days.
• No significant differences in safety or efficacy outcomes were observed between the 'Switch Rx' and 'Standard Rx' groups.

Conclusions:

• A strategy of in-lab ticagrelor followed by a 300-mg clopidogrel load transition is safe for dual antiplatelet therapy-naive patients with stable ischemic heart disease undergoing elective percutaneous intervention.
• This approach was not associated with increased bleeding or adverse events compared to standard clopidogrel therapy.