Reloading When Switching From Ticagrelor or Prasugrel to Clopidogrel Within 7 Days After STEMI

Claassens, Daniel M.F.; Tavenier, Anne H.; Hermanides, Renicus S; Vos, Gerrit J.A.; Hinrichs, Dario L.; Bergmeijer, Thomas O.; Hof, Arnoud W J van ‘t; Deneer, Vera H.M.; Berg, Jürrien M. ten

doi:10.1016/j.jcin.2020.01.001

Cited by 3 publications

(4 citation statements)

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“…However, Claassens et al found evidence that genotype-guided P2Y12 medication might overcome issues of resistance to clopidogrel. In this study, genotype-guided therapy was not inferior to more reliable P2Y12 inhibitors, ticagrelor and prasugrel [34]. However, to date, genotype-guided selection of P2Y12 inhibitor is far from clinical practice.…”

Section: Discussionmentioning

confidence: 60%

“…The mean age was 73 ± 13.4 years, and 60.7% of the patients were male. Prior myocardial infarction, prior PCI, chronic kidney disease (CKD), AF, and hypertension were frequent in this CCS cohort (prior myocardial infarction: 258 [34 Further baseline parameters, comorbidities, comedication, and laboratory parameters were assessed and can be found in the supplements (online suppl. Tables S1-S3, available at www.karger.com/doi/10.1159/000527816).…”

Section: Study Population and Characteristicsmentioning

confidence: 99%

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High On-Treatment Platelet Reactivity: Aspirin versus Clopidogrel

et al. 2022

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Background: Antithrombotic regimen in patients on oral anticoagulation (OAC) post-percutaneous coronary intervention (PCI) is challenging. At least, one antiplatelet agent in combination with OAC is recommended after PCI for 6–12 months. Clopidogrel is used most frequently in this setting. However, data comparing P2Y12 inhibition with clopidogrel versus cyclooxygenase inhibition by acetylsalicylic acid (ASA, aspirin) is missing. It is well known that the antiplatelet effects of ASA and clopidogrel are frequently impaired (high on-treatment platelet reactivity [HTPR]). In this pilot investigation, we compared the antiplatelet effects of clopidogrel versus ASA. Methods: In this retrospective single-center database analysis, we investigated platelet reactivity by light transmission aggregometry in patients under different antiplatelet regimes. Results were presented as maximum of aggregation (MoA). HTPR to ASA and to clopidogrel were assessed. Results: 755 patients were enrolled. 677 were on ASA, 521 were on clopidogrel, and 198 had OAC. Overall mean age was 73 ± 13.4 years, and 458 (60.7%) were male. HTPR to ASA occurred in 94/677 patients (13.9%), and mean arachidonic acid-induced MoA was 14.15 ± 19.04%. HTPR to clopidogrel occurred in 241/521 patients (46.3%), and mean adenosine diphosphate-induced MoA was 50.06 ± 20.42%. HTPR to clopidogrel was significantly more frequent than HTPR to ASA; single antiplatelet therapy (SAPT)-mono ASA: 27/199 (13.6%) versus mono clopidogrel: 6/18 (33.3%); p = 0.037; SAPT with OAC-OAC with ASA: 8/35 (22.9%) versus OAC with clopidogrel: 27/60 (45%); p = 0.046. Same difference in HTPR contingency could be shown in subgroups of dual antiplatelet therapy and ASA + clopidogrel + OAC therapy. Conclusion: Impaired pharmacodynamic response to clopidogrel was more frequent as HTPR to ASA. Hence, ASA should be tested in combination with OAC post-PCI.

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Section: Discussionmentioning

confidence: 60%

Section: Study Population and Characteristicsmentioning

confidence: 99%

High On-Treatment Platelet Reactivity: Aspirin versus Clopidogrel

et al. 2022

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“…In healthy Dutch volunteers, the frequency of CYP2C19 LOF variants was 24.7% [15]. In patients with cardiovascular diseases, the frequency varied between 29 and 31% [16,17]. However, this is the first study that investigated the frequency of CYP2C19 LOF variants in patients with noncardioembolic IS or TIA in a Dutch population.…”

Section: Discussionmentioning

confidence: 85%

The Frequency of CYP2C19 Loss-of-Function Variants in Patients with Non-Cardioembolic Ischemic Stroke or Transient Ischemic Attack in the Dutch Population

Heuvel¹,

Vermeer²,

Kerkhoff³

et al. 2023

Cerebrovasc Dis

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Introduction: The CYP2C19 enzyme converts clopidogrel into an active metabolite. Carriers of CYP2C19 loss-of-function (LOF) variants with a history of ischemic stroke or transient ischemic attack (TIA) using clopidogrel may have a higher risk of recurrent stroke. To study the implications of genetic CYP2C19 heterogeneity in treatment of cerebral ischemia, knowledge about the prevalence of CYP2C19 LOF variants within the population is important. We investigated the frequency of CYP2C19 LOF variants in patients with non-cardioembolic ischemic stroke or TIA in the Dutch population. Methods: We performed a single-centre observational study with a cross-sectional design in a Dutch thrombectomy-capable stroke center. We included all patients presenting with non-cardioembolic ischemic stroke or TIA. We determined the frequency of CYP2C19 LOF variants in the full cohort. Additionally, we compared the frequency of CYP2C19 LOF variants in two subgroups: patients with first-ever non-cardioembolic ischemic stroke or TIA versus patients with recurrent ischemic stroke or TIA using clopidogrel because of a history of ischemic stroke or TIA. Results: We enrolled 410 patients between 1 January 2021 and 1 July 2021. 109 (26.6%) patients were carriers of CYP2C19 LOF variants. We found no difference in the frequency of CYP2C19 LOF variants between patients with first-ever ischemic stroke or TIA versus patients with recurrent ischemic stroke or TIA using clopidogrel (25.9% versus 31.9% respectively, p = 0.31). Discussion and conclusion: About a quarter of patients with non-cardioembolic ischemic stroke or TIA in the Dutch population carry a CYP2C19 LOF variant. This is lower than estimates found in studies with Asian populations, but similar to estimates found among Caucasian patients in other parts of the world.

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“…When de-escalating in the early phase (≤30 days from the index event) a 600mg loading dose of clopidogrel should be administered 24 h after the last dose of prasugrel or ticagrelor. In a sub-analysis of the POPular Genetics trial, this method seemed save with no bleeding and thrombotic events in 172 patients who switched to clopidogrel within seven days after STEMI [32]. When de-escalating from ticagrelor to clopidogrel in the late phase (>30 days from the index event) a 600 mg loading dose 24 h after the last dose of ticagrelor is recommended, while it is not recommended to use a new loading dose when switching from prasugrel to clopidogrel in the late phase.…”

Section: How To De-escalate Antiplatelet Therapymentioning

confidence: 99%

De-Escalation of Antiplatelet Treatment in Patients with Myocardial Infarction Who Underwent Percutaneous Coronary Intervention: A Review of the Current Literature

Claassens

Sibbing

2020

JCM

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In acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), treatment with the P2Y12 inhibitors ticagrelor or prasugrel is recommended over clopidogrel due to a better efficacy, albeit having more bleeding complication. These higher bleeding rates have provoked trials investigating de-escalation from ticagrelor or prasugrel to clopidogrel in the hope of reducing bleeding without increasing thrombotic event rates. In this review, we sought to present an overview of the major trials investigating several different options for de-escalation; unguided, platelet function testing- and genotype-guided. Based on these results, and on other established literature sources, such as guidelines and expert consensus papers, we provide an overview to help decide when and how to de-escalate antiplatelet therapy in ACS patients undergoing PCI.

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Reloading When Switching From Ticagrelor or Prasugrel to Clopidogrel Within 7 Days After STEMI

Cited by 3 publications

References 3 publications

High On-Treatment Platelet Reactivity: Aspirin versus Clopidogrel

High On-Treatment Platelet Reactivity: Aspirin versus Clopidogrel

The Frequency of CYP2C19 Loss-of-Function Variants in Patients with Non-Cardioembolic Ischemic Stroke or Transient Ischemic Attack in the Dutch Population

De-Escalation of Antiplatelet Treatment in Patients with Myocardial Infarction Who Underwent Percutaneous Coronary Intervention: A Review of the Current Literature

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