Clopidogrel or ticagrelor in acute coronary syndrome patients treated with newer-generation drug-eluting stents: CHANGE DAPT

Abstract

In this observational study, the guideline-recommended ticagrelor-based primary DAPT regimen was associated with an increased event risk in consecutive ACS patients treated with newer-generation DES.

Optimal duration of dual antiplatelet therapy for coronary artery disease

“…The investigators compared 1,053 patients treated with ticagrelor with a historical control group ( n  = 1,009) treated with clopidogrel before 1 May 2014. Ticagrelor was not associated with a reduction in MACE, but it was associated with an increase in major bleeding [34]. …”

More, More, More: Reducing Thrombosis in Acute Coronary Syndromes Beyond Dual Antiplatelet Therapy—Current Data and Future Directions

“…Two recent trials aiming to show the superiority of ticagrelor compared with aspirin or clopidogrel as single antiplatelet therapy in the setting of recent stroke (6.7% versus 7.5%; 95% CI, 0.78–1.01; P =0.07)47 and peripheral arterial disease (10.8% versus 10.6%; 95% CI, 0.92–1.13; P =0.65),48 respectively, did not show a statistical difference. Despite the clear superiority of ticagrelor over clopidogrel exhibited in PLATO (Platelet Inhibition and Patient Outcomes),49 in the acute setting, results from the recent CHANGE DAPT (Change of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome) trial have reinitiated the argument about the preferred antiplatelet therapy in the era of the new drug‐eluting stents with thinner struts, mitigating against stent thrombosis 50…”

“…Direct oral thrombin (FIIa) inhibitors are a class of anticoagulants that act by directly inhibiting thrombin to delay clotting. 31 This phase II, randomized, double-blind, placebo-controlled trial of 1861 patients with recent ACS assessed the addition of different doses of dabigatran (50,75,110, and 150 mg BID) to DAPT that included clopidogrel.…”

“…Despite the clear superiority of ticagrelor over clopidogrel exhibited in PLATO (Platelet Inhibition and Patient Outcomes), 49 in the acute setting, results from the recent CHANGE DAPT (Change of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome) trial have reinitiated the argument about the preferred antiplatelet therapy in the era of the new drug-eluting stents with thinner struts, mitigating against stent thrombosis. 50 The duration of the preferred antithrombotic regimen is another important aspect of choosing the right regimen for the right patient, for whom prolonged treatment with DAPT reduces ischemic end points at the cost of increased bleeding, as exhibited in the PEGASUS TIMI-54 (Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54) 51 study. The 2017 ESC guideline states that prolonged duration of DAPT may be considered for patients at high thrombotic risk, such as those undergoing complex PCI or those implanted with a bioresorbable vascular scaffold, 38 and particularly for those who have tolerated DAPT without a bleeding complication.…”

Search for an optimal efficacy-to-safety ratio for anti-platelet therapy of ischemic heart disease

“…-ДАТ, включавшую АСК и тикагрелор (n = 1 053). Ежегодная частота композитной первичной конечной точки -смерть от всех причин, ИМ, инсульт или большое кровотечение составляла 5,1% против 7,8% (р = 0,02), больших кровотечений -1,2% против 2,7% (р = 0,02) в период назначения клопидогрела и тикагрелора соответственно, без различий в частоте ишемических осложнений [33].…”