Ticagrelor in Triple Antithrombotic Therapy: Predictors of Ischemic and Bleeding Complications

Abstract

The risk of bleeding and ischemic complications among patients on TT is similar between those on ticagrelor and clopidogrel. However, caution with use of bridging anticoagulation should be taken when using ticagrelor.

Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

“…These observations have raised interest in investigating the newer P2Y 12 receptor inhibitors for PCI patients with AF, for which there is limited data, though an increased risk of bleeding. [148][149][150] In a study of patients needing triple therapy, substitution of prasugrel for clopidogrel (mostly because of identified poor clopidogrel response) was accompanied by a 3-fold increased risk of bleeding. 148 These observations have prompted studies to assess discontinuation of aspirin therapy as a strategy to minimize bleeding complications.…”

“…148 These observations have prompted studies to assess discontinuation of aspirin therapy as a strategy to minimize bleeding complications. 150 Preliminary investigations have suggested reduction in bleeding complications, without a tradeoff in efficacy, linked with discontinuation of aspirin therapy in PCI patients treated with a VKA and clopidogrel. 140 However, this approach needs to be validated in larger studies and include NOACs and new P2Y 12 receptor inhibitors.…”

P2Y12 inhibitors with oral anticoagulation for percutaneous coronary intervention with atrial fibrillation: a systematic review and meta-analysis

“…Twenty-one full-text manuscripts were assessed for eligibility; from which 14 were excluded due to not meeting inclusion criteria. Seven studies, including three randomised controlled trials, were included in our final analysis 6–8 16–19. Randomised controlled trials included: Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI (PIONEER-AF),6 Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation (RE-DUAL PCI)7 and Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation (AUGUSTUS) 8…”

Similar Impact of Clopidogrel or Ticagrelor on Carotid Atherosclerotic Plaque Inflammation

“…In the previous Platelet Inhibition and Patient Outcomes ( PLATO ) trial, the cardiovascular benefits of ticagrelor outweighed those of clopidogrel, despite more spontaneous bleeds . These benefits may not be fully explained by platelet inhibition alone.…”