Switching Ticagrelor to 600 mg or 300 mg Clopidogrel Loading Bridge in Patients with Unstable Angina

Autor:	Mehmet Mustafa Can, Erdal Belen, Ziya Apaydın, Zafer Güven, Sinem Cakal, Halil İbrahim Biter, Beytullah Çakal, Aydin Rodi Tosu, İbrahim Karaca, Muhsin Kalyoncuoğlu
Rok vydání:	2021
Předmět:	unstable angina medicine.medical_specialty Acute coronary syndrome medicine.medical_treatment 030204 cardiovascular system & hematology Loading dose Article 03 medical and health sciences 0302 clinical medicine Internal medicine medicine cardiovascular diseases 030212 general & internal medicine Myocardial infarction business.industry Unstable angina Percutaneous coronary intervention vascular disease General Medicine antiplatelet agent medicine.disease Clopidogrel de-escalation Conventional PCI Cardiology Medicine business Ticagrelor switching protocols coronary artery disease circulatory and respiratory physiology medicine.drug
Zdroj:	Journal of Clinical Medicine Volume 10 Issue 11 Journal of Clinical Medicine, Vol 10, Iss 2463, p 2463 (2021)
ISSN:	2077-0383
DOI:	10.3390/jcm10112463
Popis:	Ticagrelor is believed to be a more potent and faster antiplatelet agent compared with clopidogrel and may result in lower ischemic outcomes in patients with acute coronary syndrome. However, the best strategy of switching from ticagrelor to clopidogrel is unclear. Current guidelines advocate clopidogrel bridging with a 600 mg loading dose (LD). This study aimed to compare the safety and feasibility of switching protocols from ticagrelor to clopidogrel 600 mg or 300 mg LD in patients with unstable angina pectoris (USAP). One hundred and eighty patients with USAP undergoing adhoc percutaneous coronary intervention (PCI) received preprocedural ticagrelor 180 mg/daily. The decision to switch antiplatelet therapy to clopidogrel with either 300 mg LD or 600 mg LD at 12 h was left to the discretion of the treating physician. The primary outcome was a composite of an efficacy endpoint major adverse cardiac and cerebrovascular events (MACCEs) and a safety endpoint Bleeding Academic Research Consortium scale (BARC) (≥1). There were no differences in our composite clinical endpoint of MACCE between the two strategies, with one event occurring in each group. One patient in each group had myocardial infarction due to stent thrombosis, and the patient in the 300 mg switching group died due to stent thrombosis. No difference between the two arms was observed in terms of BARC bleeding criteria. This study showed that among USAP patients undergoing PCI, switching to clopidogrel with 300 mg LD showed no significant difference compared to 600 mg clopidogrel LD. Ticagrelor LD in ad hoc PCI and de-escalation to clopidogrel with 300 mg LD could translate to lower costs for patients with USAP without compromising safety and efficacy.
Databáze:	OpenAIRE
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