Benefit of Switching Dual Antiplatelet Therapy After Acute Coronary Syndrome According to On-Treatment Platelet Reactivity

Deharo, Pierre; Quilici, Jacques; Camoin-Jau, Laurence; Johnson, Tom; Bassez, C.; Bonnet, Guillaume; Fernández, M. Juárez; Ibrahim, Manal; Suchon, Pierre; Verdier, Valentine; Fourcade, Laurent; Morange, Pierre‐Emmanuel; Bonnet, Jean Louis; Alessi, Marie‐Christine; Cuisset, Thomas

doi:10.1016/j.jcin.2017.08.044

Cited by 38 publications

(19 citation statements)

References 24 publications

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“…However, significant reductions in rehospitalization for unstable angina and revascularization were observed in the ticagrelor group. Unlike previous data, 8,10,13 our study showed that in patients with STEMI undergoing successful primary PCI, de-escalation was associated with a high incidence of secondary ischemic events as compared to ticagrelor, but with a low incidence as compared to clopidogrel. Our result supported the SCOPE registry, which has shown that de-escalation increased the rate of adverse cardiovascular events in the first month after hospital discharge.…”

Section: Discussioncontrasting

confidence: 97%

“…Although some previous studies have reported the safety of deescalation, the follow-up duration was short. 8,10,13 In 12 months follow-up, we found that as compared to clopidogrel, de-escalation did not increase the risk of bleeding events. Hence, de-escalation may be safe.…”

Section: Discussionmentioning

confidence: 74%

“…12 However, different studies addressing de-escalation in recent years showed contradictory efficacy and safety of switching. 8,[13][14][15] Although some studies assessed the pharmacodynamic effects of loading dose during de-escalation to clopidogrel, [3][4][5]16 the best strategy of switching remains unclear because of the lack of long-term study of clinical outcomes.…”

mentioning

confidence: 99%

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Switching from ticagrelor to clopidogrel in patients with ST‐segment elevation myocardial infarction undergoing successful percutaneous coronary intervention in real‐world China: Occurrences, reasons, and long‐term clinical outcomes

Wang

et al. 2018

Clinical Cardiology

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Section: Discussioncontrasting

confidence: 97%

Section: Discussionmentioning

confidence: 74%

mentioning

confidence: 99%

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Switching from ticagrelor to clopidogrel in patients with ST‐segment elevation myocardial infarction undergoing successful percutaneous coronary intervention in real‐world China: Occurrences, reasons, and long‐term clinical outcomes

Wang

et al. 2018

Clinical Cardiology

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“…This effect was mostly driven by the 60% decrease in bleeding events in the switched group, without an increase in ischemic events. It is of note that the switched DAPT strategy was superior in terms of bleeding regardless of the initial platelet reactivity [73]. The recent TWILIGHT study further supported a strategy based on a shorter DAPT [74].…”

Section: Do Platelet Function Tests Help To Avoid Bleeding Events?mentioning

confidence: 85%

Platelet Function Test Use for Patients with Coronary Artery Disease in the Early 2020s

Fontana

Roffi

Reny

2020

JCM

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In the field of antithrombotics, precision medicine is of particular interest, as it may lower the incidence of potentially life-threatening side effects. Indeed, antiplatelet drugs such as P2Y12 inhibitors are one of the most common causes of emergency admissions for drug-related adverse events. The last ten years have seen a continuous debate on whether platelet function tests (PFTs) should be used to tailor antiplatelet drugs to cardiovascular patients. Large-scale randomized studies investigating the escalation of antiplatelet therapies according to the results of PFTs were mostly negative. Potent P2Y12 inhibitors are recommended as a first-line treatment in acute coronary syndrome patients, bringing the bleeding risk at the forefront. De-escalation from prasugrel or ticagrelor to clopidogrel is now considered, with or without the use of a PFT. This review covers recent advances in escalation and de-escalation strategies based on PFTs in various clinical settings. It also describes the main features of the most popular platelet function tests as well as the potential added value of genetic testing. Finally, we detail practical suggestions on how PFTs could be used in clinical practice.

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“…It is recognized that the efficacy of platelet inhibition due to antiplatelet therapy including novel potent P2Y12 inhibitors could be associated with a patient's BMI [8]. In other words, high or low BMI could lead to an inappropriate balance between anti-ischemic and bleeding risks [9][10][11]. Therefore, assessment of different antiplatelet strategies after PCI, stratified according to BMI, may provide additional insight into patients with a "high-risk" BMI.…”

Section: Introductionmentioning

confidence: 99%

The association of body mass index with long-term clinical outcomes after ticagrelor monotherapy following abbreviated dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a prespecified sub-analysis of the GLOBAL LEADERS Trial

et al. 2020

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Background The efficacy of antiplatelet therapies following percutaneous coronary intervention (PCI) may be affected by body mass index (BMI). Methods and results This is a prespecified subgroup analysis of the GLOBAL LEADERS trial, a prospective, multicenter, open-label, randomized controlled trial in an all-comer population undergoing PCI, comparing the experimental strategy (23-month ticagrelor monotherapy following 1-month dual antiplatelet therapy [DAPT]) with a reference regimen (12-month aspirin monotherapy following 12-month DAPT). A total of 15,968 patients were stratified by baseline BMI with prespecified threshold of 27 kg/m 2 . Of those, 6973 (43.7%) patients with a BMI < 27 kg/m 2 had a higher risk of all-cause mortality at 2 years than those with BMI ≥ 27 kg/m 2 (adjusted HR 1.24, 95% CI 1.02-1.49). At 2 years, the rates of the primary endpoint (all-cause mortality or new Q-wave myocardial infarction) were similar between treatment strategies in either BMI group (p interaction = 0.51). In acute coronary syndrome, however, the experimental strategy was associated with significant reduction of the primary endpoint compared to the reference strategy in patients with BMI < 27 kg/m 2 (HR 0.69, 95% CI 0.51-0.94), but not in the ones with BMI ≥ 27 kg/m 2 (p interaction = 0.047). In chronic coronary syndrome, there was no between-group difference in the efficacy and safety of the two antiplatelet strategies. Conclusions Overall, BMI did not influence the treatment effect seen with ticagrelor monotherapy; however, a beneficial effect of ticagrelor monotherapy was seen in ACS patients with BMI < 27 kg/m 2 . Trial registration The trial has been registered with ClinicalTrials.gov, Number NCT01813435.Masafumi Ono and Ply Chichareon contributed equally to this work. Electronic supplementary materialThe online version of this article (https ://doi.

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Benefit of Switching Dual Antiplatelet Therapy After Acute Coronary Syndrome According to On-Treatment Platelet Reactivity

Abstract: Switched DAPT was superior regardless of initial platelet reactivity but the benefit was greater in LTPR patients. Indeed, the switched strategy was highly effective in this group, which had impaired prognosis with unchanged DAPT but similar prognosis after switching.

Cited by 38 publications

References 24 publications

Switching from ticagrelor to clopidogrel in patients with ST‐segment elevation myocardial infarction undergoing successful percutaneous coronary intervention in real‐world China: Occurrences, reasons, and long‐term clinical outcomes

Switching from ticagrelor to clopidogrel in patients with ST‐segment elevation myocardial infarction undergoing successful percutaneous coronary intervention in real‐world China: Occurrences, reasons, and long‐term clinical outcomes

Platelet Function Test Use for Patients with Coronary Artery Disease in the Early 2020s

The association of body mass index with long-term clinical outcomes after ticagrelor monotherapy following abbreviated dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a prespecified sub-analysis of the GLOBAL LEADERS Trial

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