Clopidogrel versus Ticagrelor in CYP2C19 Loss-of-Function Allele Noncarriers: A Real-World Study in China

Front. Cardiovasc. Med.

Yang

2022

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PurposePrevious trials have demonstrated that ticagrelor was superior to clopidogrel in acute coronary syndrome (ACS) patients. However, several recent studies showed that ticagrelor was associated with a significantly higher risk of bleeding compared with clopidogrel, especially in East Asian patients. Low-dose ticagrelor might improve the safety of ACS patients in the Chinese population. Therefore, this study mainly explored the low-dose ticagrelor in Chinese ACS patients.MethodsA total of 199 ACS patients were enrolled in this study. The maximum platelet aggregation rate induced by adenosine-5-diphosphate (ADP) was detected by light transmittance aggregometry (LTA). Platelet aggregation rate induced by ADP of more than or equal to 42.9% was defined as high on-treatment platelet reactivity (HPR) to P2Y12 inhibitors. All patients were followed up for at least 12 months. Clinical outcomes, changes of antiplatelet regimen, medication compliance and adverse reactions were collected.ResultsPatients were divided into three groups according to the P2Y12 inhibitors, including 87 cases in clopidogrel (75 mg once a day) group, 41 cases in ticagrelor 60 mg (twice a day) group, and 71 cases in ticagrelor 90 mg (twice a day) group. ADP-induced platelet aggregation rates in ticagrelor 60 mg group and 90 mg group were 28.4 (19.6, 42.9) and 22.33 (15.1, 34.7) respectively, which were significantly lower than those in clopidogrel group 49.3 (36.5, 61.0) with adjusted P < 0.001. At the same time, there was no significant difference in ADP-induced platelet aggregation rate between ticagrelor 60 mg and 90 mg group (adjusted P = 0.105). Compared with clopidogrel, the proportion of normal on-treatment platelet reactivity (NPR) of ticagrelor 60 mg and ticagrelor 90 mg were significantly higher than that of clopidogrel, and the proportion of NPR of ticagrelor 90 mg group was significantly higher than that of ticagrelor 60 mg group.ConclusionsPatients of ticagrelor 60 mg and ticagrelor 90 mg had comparable platelet aggregation rates induced by ADP, and both of them had significantly more potent antiplatelet aggregation activity detected by LTA than clopidogrel.

Section: Discussionsupporting

confidence: 76%

Low-dose and standard-dose ticagrelor compared with clopidogrel in patients with acute coronary syndromes: A cohort study from china

Front. Cardiovasc. Med.

Yang

2022

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“…The reason might be that Chinese clinicians were more willing to prescribe clopidogrel than ticagrelor compared with European and American countries. 45,46 Therefore, adjustment of P2Y12 receptor inhibitors based on PFT, especially the upgrading of P2Y12 receptor inhibitors, might have more clinical benefits for Chinese patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of individualized antiplatelet therapy based on platelet function test in patients after percutaneous coronary intervention: a systematic review and meta-analysis

Journal of Cardiovascular Pharmacology

Lin

et al. 2022

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“…Standardized differences of ≤ 0.10 indicated well-balanced covariates while using IPTW. Covariates used in these two models were selected based on the previous studies and were reported to be related to clinical outcomes ( 16 – 18 ). The final models included age, sex, body mass index (BMI), smoking status, PCI indication, PCI type, stent number, multiple-vessel disease, medical history (previous PCI with stenting, previous coronary artery bypass grafting, hypertension, hyperlipidemia, diabetes mellitus, MI, heart failure, and cerebral infarction), left ventricular ejection fraction, estimated glomerular filtration rate, and discharge medication (statin, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, beta blocker, and proton pump inhibitor).…”

Section: Methodsmentioning

confidence: 99%

Ticagrelor vs. Clopidogrel in Older Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: Insights From a Real-World Registry

Front. Cardiovasc. Med.

Shi

et al. 2022

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Background and ObjectivesIt is unclear whether more potent P2Y12 inhibitors are of benefit to older patients who are at high risk for both ischemia and bleeding. We conducted an observational study to compare the clinical outcomes of clopidogrel and ticagrelor uses in older patients with an acute coronary syndrome (ACS).MethodsOlder patients (aged ≥65 years) with ACS who underwent percutaneous coronary intervention (PCI) were divided into clopidogrel-treated and ticagrelor-treated groups. The primary observational endpoint was the occurrence of net adverse clinical and cerebral events (NACCEs) during a 12-month period, which is defined as the composite endpoint of all-cause death, myocardial infarction (MI), stroke, stent thrombosis, urgent coronary revascularization, and clinically significant bleeding. The secondary endpoints were clinically significant bleeding and major adverse clinical and cerebral events (MACCEs).ResultsThis study included a total of 2,611 patients. Of them, 1,636 received clopidogrel and 975 received ticagrelor. Between patients receiving clopidogrel and those receiving ticagrelor, no significant differences were noted in NACCE (8.4 vs. 9.7%, respectively; adjusted hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.66–1.12) or MACCE (7.1 vs. 7.0%, respectively; adjusted HR, 1.13; 95% CI, 0.83–1.55) during the 12-month follow-up period. In contrast, the occurrence of clinically significant bleeding was significantly less in clopidogrel-treated patients compared with that in ticagrelor-treated patients (27, 1.7%, vs. 31, 3.2%, respectively; adjusted HR, 0.42; 95% CI, 0.25–0.69). Stratified analyses revealed no significant association between age (≥75 years vs. <75 years) and treatment condition in terms of primary or secondary endpoints.ConclusionThis study showed that clopidogrel and ticagrelor had comparable net clinical benefits in patients with ACS aged ≥65 years. Additionally, clopidogrel was associated with a significantly lower risk of major bleeding than ticagrelor without an increase in ischemic risk. These findings suggest that clopidogrel is an effective alternative to the more potent P2Y12 inhibitor ticagrelor in older patients.