Oral antiplatelet therapy and platelet inhibition: An experience from a tertiary care center

Dalal, Jamshed; Digrajkar, Aarti; Gandhi, Ashish

doi:10.1016/j.ihj.2015.12.022

Cited by 11 publications

(9 citation statements)

References 33 publications

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“…Similar to the PLATO trial, a large prospective registry from Sweden has shown better outcomes with ticagrelor as compared to clopidogrel [4]. Though few case reports from India attributed increased risk of bleeding to newer antiplatelet agents like ticagrelor [5], large observational studies have documented the safety of ticagrelor and prasugrel in the Indian subset of patients [6][7][8]. Similar to the other two studies from India, we observed ticagrelor to be safe in Indian patients.…”

Section: Discussionsupporting

confidence: 84%

Effect of discontinuation of ticagrelor and switching-over to other P2Y12 agents in patients with acute coronary syndrome: a single-center real-world experience from India

et al. 2021

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Background Dual antiplatelet therapy is the current standard of care after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). We intended to study the pattern of use of ticagrelor in patients with acute coronary syndrome undergoing PCI and the effect of switching over to other P2Y12 receptor inhibition on clinical outcomes. Results All patients aged > 18 years who had been admitted with acute coronary syndrome and had been provided ticagrelor as the second antiplatelet agent were included as study participants. The primary outcome of the study was the composite outcome of death, recurrent myocardial infarctions, re-intervention, and major bleeding. We studied 321 patients (54 female patients, 16.82%). The mean age of the patients was 56.65 ± 11.01 years. Ticagrelor was stopped in 76.7% on follow-up. It was stopped in 6.3%, 13.5%, 13.1%, 21.9%, and 45.1% of patients during the first month but after discharge, between first and third months, between 3 and 6 months, between 6 and 12 months, and after 12 months, respectively. In the majority of patients, ticagrelor was replaced by clopidogrel (97.9%). It was stopped according to the physician’s discretion in 79.3% of patients, whereas it was the cost of the drug that made the patient to get swapped to another agent in 18.6%. No difference in the primary composite outcome was observed between the groups where ticagrelor was continued post 12 months and ticagrelor was continued and ticagrelor was switched-over to another agent. Similarly, no difference in death, recurrent myocardial infarctions, re-interventions, or major bleeding manifestations was observed between the two groups. Conclusion In patients with acute coronary syndrome who undergo PCI, we observed that early discontinuation of ticagrelor and switching over to other P2Y12 inhibitors after discharge did not affect clinical outcomes.

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Section: Discussionsupporting

confidence: 84%

Effect of discontinuation of ticagrelor and switching-over to other P2Y12 agents in patients with acute coronary syndrome: a single-center real-world experience from India

et al. 2021

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“…The related studies viewed any CT ≤106 s as clopidogrel non-responders [14]. To better reflect variable response rates to clopidogrel, other authors have suggested a reactivity threshold of more than 50% platelet inhibition to prevent recurrence of ischemic events during clopidogrel treatment [26, 27]. This threshold was based on clinical observations that, among patients receiving clopidogrel in PCI, none of the subjects with a residual platelet reactivity of < 50% presented with ischemic events, while 100% of subjects with recurrence of thrombosis had > 50% residual platelet reactivity [19].…”

Section: Discussionmentioning

confidence: 99%

Platelet Function Testing in Neurovascular Procedures: Tool or Gimmick?

et al. 2019

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Background: Platelet inhibitors are used to prevent thromboembolic complications related to neurovascular stenting (NVS) procedures. Despite substantial inter-individual variability of functional platelet inhibition, the value of platelet function tests (PFT) to assess inhibition remains controversial. Objective: This study was conducted to compare differences in thromboembolic complication rates associated with NVS in platelet-inhibited patients with and without PFT. Clinical neurological outcomes were assessed by differences in the modified Rankin Scale (mRS). Materials and Methods: One hundred seventeen consecutive patients underwent elective NVS procedures within a 7-year period. All patients received aspirin and clopidogrel 8 days before the procedure. Fifty-two patients were treated without assessment of platelet inhibition, and 65 patients were tested for clopidogrel resistance. When clopidogrel resistance was revealed, corresponding patients were converted to ticagrelor. Changes in mRS and thromboembolic event rates were compared between the 2 cohorts. Results: Thirty-five percent of patients from the cohort subjected to PFT tests showed inadequate platelet inhibition under clopidogrel and were converted to ticagrelor. Compared to the non-PFT test cohort, neurological deficits were significantly reduced (12 vs. 0%; p = 0.009) and a lower number of thromboembolic events was found (12 vs. 3%; p > 0.05) within the test cohort. Conclusion: PFT appears to identify patients with clopidogrel resistance prior to NVS procedures. When non-responders are converted to alternative platelet inhibitors, neurological outcomes and thromboembolic complication rates may improve. Consequently, this study provides preliminary evidence that PFT may be a useful clinical tool to enhance procedural safety and improve clinical outcomes in NVS procedures.

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“…The relative risks and benefits of anti-platelet regimens in TAVR patients are not well characterized (7, 8). Ticagrelor results in more potent platelet inhibition than does clopidogrel (9). In addition, it reduces cerebral ischemic events in patients with acute coronary syndromes (ACS) without significantly increasing major bleeding complications (10).…”

Section: Introductionmentioning

confidence: 99%

Ticagrelor vs Clopidogrel: the Impact of Platelet Inhibition on Cerebrovascular Microembolic Events during TAVR

Vavuranakis

Kalantzis²,

Voudris

et al. 2020

Preprint

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ObjectivesTo evaluate the effects of ticagrelor versus clopidogrel and of platelet inhibition on the number of cerebrovascular microembolic events, in patients undergoing transcatheter aortic valve replacement (TAVR).BackgroundThe impact of the antiplatelet regimen and the extent of associated platelet inhibition on cerebrovascular microembolic events during TAVR are unknown.MethodsPatients scheduled for TAVR were randomized prior to the procedure to either aspirin and ticagrelor or to aspirin and clopidogrel. Platelet inhibition was expressed in P2Y12 Reaction Units (PRU) and percentage of inhibition. High intensity transient signals (HITS) were assessed with transcranial Doppler (TCD). Safety outcomes were recorded according to the VARC-2 definitions.ResultsAmong 90 patients randomized, six had inadequate TCD signal. The total number of procedural HITS was lower in the ticagrelor group (416.5 [324.8, 484.2]) (42 patients) than in the clopidogrel group (723.5 [471.5, 875.0]) (42 patients), p< 0.001. After adjusting for the duration of the procedure, diabetes, extra-cardiac arteriopathy, BMI, and aortic valve calcium content, patients on ticagrelor had on average 255.9 (95% CI: [-335.4, -176.4]) fewer total procedural HITS, than did patients on clopidogrel. Platelet inhibition was greater in those randomized to ticagrelor 26 [10, 74.5] PRU than in those randomized to clopidogrel 207.5 [120-236.2] PRU, p<0.001 and correlated significantly with procedural HITS (r=0.5, p<0.05). This protective effect was not associated with an increase in complications.ConclusionsTicagrelor resulted in fewer procedural HITS, compared to clopidogrel, in patients undergoing TAVR, while achieving greater platelet inhibition, without increasing the risk for complications.Clinical Trial(ClinicalTrials.gov Identifier: NCT02989558)CONDENSED ABSTRACTWe conducted a two-center, prospective, open label, randomized, controlled clinical trial to compare the efficacy of ticagrelor vs clopidogrel in preventing cerebrovascular embolic events as assessed by transcranial Doppler during TAVR.The total number of procedural HITS was lower in the ticagrelor group (416.5 [324.8, 484.2]) than in the clopidogrel group (723.5 [471.5, 875.0]), p< 0.001. Patients on ticagrelor had on average 255.9 (95% CI: [-335.4, -176.4]) fewer total procedural HITS than those on clopidogrel. This protective effect was not associated with an increase in complications.

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Oral antiplatelet therapy and platelet inhibition: An experience from a tertiary care center

Cited by 11 publications

References 33 publications

Effect of discontinuation of ticagrelor and switching-over to other P2Y12 agents in patients with acute coronary syndrome: a single-center real-world experience from India

Effect of discontinuation of ticagrelor and switching-over to other P2Y12 agents in patients with acute coronary syndrome: a single-center real-world experience from India

Platelet Function Testing in Neurovascular Procedures: Tool or Gimmick?

Ticagrelor vs Clopidogrel: the Impact of Platelet Inhibition on Cerebrovascular Microembolic Events during TAVR

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