Prevalence of adverse events during ticagrelor versus clopidogrel treatment and its association with premature discontinuation of dual antiplatelet therapy in East Asian patients with acute coronary syndrome

Kang, Min Gyu; Ahn, Jong Hwa; Kim, Kyehwan; Koh, Jin‐Sin; Park, Joeng Rang; Hwang, Seok Jae; Park, Yongwhi; Tantry, Udaya S.; Gurbel, Paul A.; Hwang, Jin‐Yong; Jeong, Yun-Mi

doi:10.3389/fcvm.2022.1053867

Cited by 6 publications

(4 citation statements)

References 32 publications

(45 reference statements)

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“…Given these findings, it is likely that long-acting cilostazol may have better pharmacological effects in patients with documented VSA. The low side effects early in treatment and once-daily dosing have the advantage of maintaining medication adherence, which can improve long-term outcomes [21].…”

Section: Discussionmentioning

confidence: 99%

Long-acting cilostazol versus isosorbide mononitrate for patients with vasospastic angina: a randomized controlled trial

Kang,

Ahn,

Hwang

et al. 2024

Coronary Artery Disease

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Background Cilostazol has a vasodilatory function that may be beneficial for patients with vasospastic angina (VSA). We conducted a randomized, open-label, controlled trial to compare the efficacy and safety of long-acting cilostazol and isosorbide mononitrate (ISMN) for VSA. Methods The study included patients with confirmed VSA between September 2019 and May 2021. Participants were randomly assigned to receive long-acting cilostazol (test group, 200 mg once daily) or conventional ISMN therapy (control group, 20 mg twice daily) for 4 weeks. The clinical efficacy and safety were evaluated using weekly questionnaires. Results Forty patients were enrolled in the study (long-acting cilostazol, n = 20; ISMN, n = 20). Baseline characteristics were balanced between the two groups. Long acting cilostazol showed better angina symptom control within the first week compared to ISMN [reduction of pain intensity score, 6.0 (4.0–8.0) vs. 4.0 (1.0–5.0), P = 0.005; frequency of angina symptom, 0 (0–2.0) vs. 2.0 (0–3.0), P = 0.027, respectively]. The rate of neurological adverse reactions was lower in the cilostazol group than in the ISMN group (headache or dizziness, 40 vs. 85%, P = 0.009; headache, 30 vs. 70%, P = 0.027). Conclusion Long-acting cilostazol provided comparable control of angina and fewer adverse neurologic reactions within 4 weeks compared to ISMN. Long-acting cilostazol provides more intensive control of angina within 1 week, suggesting that it may be an initial choice for the treatment of VSA.

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Section: Discussionmentioning

confidence: 99%

Long-acting cilostazol versus isosorbide mononitrate for patients with vasospastic angina: a randomized controlled trial

Kang,

Ahn,

Hwang

et al. 2024

Coronary Artery Disease

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“…Approved regimens of prasugrel and ticagrelor achieve a higher mean level of platelet inhibition than clopidogrel [25][26][27] and are associated with higher rates of minor and major bleeding 9,10,[28][29][30] (Table 2). Consistently high levels of P2Y 12 inhibition with standard doses of prasugrel (10 mg daily) and ticagrelor (90 mg twice daily) translate to similar rates of bleeding for each agent 29,31 . However, the wide interindividual pharmacodynamic response to clopidogrel is associated with variation in individual bleeding risk, such that patients with greater P2Y 12 inhibition have higher rates of bleeding 31,32 .…”

Section: Differences Between Antiplatelet Agentsmentioning

confidence: 92%

“…Consistently high levels of P2Y 12 inhibition with standard doses of prasugrel (10 mg daily) and ticagrelor (90 mg twice daily) translate to similar rates of bleeding for each agent 29,31 . However, the wide interindividual pharmacodynamic response to clopidogrel is associated with variation in individual bleeding risk, such that patients with greater P2Y 12 inhibition have higher rates of bleeding 31,32 . The risk of bleeding related to surgery (either cardiac or non-cardiac) depends on the timing of P2Y 12 inhibitor cessation before surgery, the mean level of platelet P2Y 12 inhibition during treatment, and whether the inhibitory effect is reversible (ticagrelor) or irreversible (clopidogrel and prasugrel) 33 .…”

Section: Differences Between Antiplatelet Agentsmentioning

confidence: 92%

De-escalation or abbreviation of dual antiplatelet therapy in acute coronary syndromes and percutaneous coronary intervention: a Consensus Statement from an international expert panel on coronary thrombosis

et al. 2023

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Conventional dual antiplatelet therapy (DAPT) for patients with acute coronary syndromes undergoing percutaneous coronary intervention comprises aspirin with a potent P2Y purinoceptor 12 (P2Y 12 ) inhibitor (prasugrel or ticagrelor) for 12 months. Although this approach reduces ischaemic risk, patients are exposed to a substantial risk of bleeding. Strategies to reduce bleeding include de-escalation of DAPT intensity (downgrading from potent P2Y 12 inhibitor at conventional doses to either clopidogrel or reduced-dose prasugrel) or abbreviation of DAPT duration. Either strategy requires assessment of the ischaemic and bleeding risks of each individual. De-escalation of DAPT intensity can reduce bleeding without increasing ischaemic events and can be guided by platelet function testing or genotyping. Abbreviation of DAPT duration after 1-6 months, followed by monotherapy with aspirin or a P2Y 12 inhibitor, reduces bleeding without an increase in ischaemic events in patients at high bleeding risk, particularly those without high ischaemic risk. However, these two strategies have not yet been compared in a head-to-head clinical trial. In this Consensus Statement, we summarize the evidence base for these treatment approaches, provide guidance on the assessment of ischaemic and bleeding risks, and provide consensus statements from an international panel of experts to help clinicians to optimize these DAPT approaches for individual patients to improve outcomes.Sections Although the ARC-HBR criteria and the PRECISE-DAPT Risk Calculator can be adequately applied to real-world cohorts, several important clinical risk factors for bleeding are not covered by these scores (such as low body weight, frailty, heart failure and peripheral artery disease) and, therefore, risk of bleeding might be underestimated in these patients 24 . Methods for consensus recommendationsWe conducted a search of the literature to identify clinical trials of de-escalation of DAPT intensity or abbreviation of DAPT duration in patients with ACS treated with PCI. The PubMed, Embase and Cochrane Library databases were searched for papers published up to November 2022, with no restriction on language. Reference lists of selected papers were also checked for additional relevant papers. The authors worked on allocated sections of this Consensus Statement in pairs. All the authors reviewed all sections of the manuscript and participated in a series of 'rounds', in which the manuscript was shared with all other authors and the comments made were used to inform and evolve the manuscript in the next round. Video discussions between the authors were also conducted. All the authors judged the available evidence, leading to the consensus recommendations. Risk of bleeding in clinical trialsIn clinical trials of DAPT, the incidence of major bleeding in the 12 months after PCI among patients with ACS is 1-10% depending Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author...

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“…Currently approved doses of prasugrel (10 mg a day) and ticagrelor (90 mg twice a day) achieve a higher level of platelet inhibition than clopidogrel, which are associated with higher rates of serious bleeding and early discontinuation of DAPT in East Asian patients. 143 , 144 …”

Section: Optimal Medical Therapy After Physiologic Assessmentmentioning

confidence: 99%

Practical Application of Coronary Physiologic Assessment

Koo,

Hwang,

Park

et al. 2023

JACC: Asia

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Prevalence of adverse events during ticagrelor versus clopidogrel treatment and its association with premature discontinuation of dual antiplatelet therapy in East Asian patients with acute coronary syndrome

Cited by 6 publications

References 32 publications

Long-acting cilostazol versus isosorbide mononitrate for patients with vasospastic angina: a randomized controlled trial

Long-acting cilostazol versus isosorbide mononitrate for patients with vasospastic angina: a randomized controlled trial

De-escalation or abbreviation of dual antiplatelet therapy in acute coronary syndromes and percutaneous coronary intervention: a Consensus Statement from an international expert panel on coronary thrombosis

Practical Application of Coronary Physiologic Assessment

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