P2Y₁₂ Inhibition in Patients Requiring Oral Anticoagulation After Percutaneous Coronary Intervention: The SWAP-AC-2...

Area of Science:

• Cardiology
• Pharmacology
• Interventional Cardiology

Background:

• Dual antithrombotic therapy (DAT) with clopidogrel is standard for patients on novel oral anticoagulants (NOACs) undergoing percutaneous coronary intervention (PCI).
• Impaired response to clopidogrel poses a risk in this patient population.

Purpose of the Study:

• To compare the pharmacodynamic effects of low-dose ticagrelor versus clopidogrel in NOAC-treated patients with impaired clopidogrel response, identified by the ABCD-GENE score.
• To assess P2Y12 signaling inhibition in patients with high ABCD-GENE scores.

Main Methods:

• A prospective, randomized study involving NOAC-treated patients undergoing PCI.
• Patients with ABCD-GENE score ≥10 (impaired response) were randomized to ticagrelor (60 mg twice daily) or clopidogrel (75 mg once daily).
• Pharmacodynamic assessments included P2Y12 reaction units (PRU), light transmittance aggregometry, and vasodilator-stimulated phosphoprotein at baseline and 30 days.

Main Results:

• Ticagrelor-based DAT significantly reduced PRU levels at 30 days compared to clopidogrel-based DAT (trough and peak).
• Trough PRU levels were lower with ticagrelor compared to the clopidogrel arm and the control arm (clopidogrel for ABCD-GENE <10).
• Results were consistent across different platelet function assays; other thrombosis markers were unaffected.

Conclusions:

• Ticagrelor-based dual antithrombotic therapy (60 mg twice daily) effectively reduces platelet P2Y12 reactivity in NOAC-treated patients with impaired clopidogrel response undergoing PCI.
• This suggests ticagrelor is a viable alternative for tailoring antiplatelet therapy in this specific patient group.