P2Y 12 Inhibition in Patients Requiring Oral Anticoagulation After Percutaneous Coronary Intervention: The SWAP-AC-2 Study
Among patients treated with a novel oral anticoagulant (NOAC) undergoing percutaneous coronary intervention (PCI), combination therapy with clopidogrel (ie, known as dual antithrombotic therapy [DAT]) is the treatment of choice. However, there are concerns for individuals with impaired response to c...
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| Veröffentlicht in: | JACC. Cardiovascular interventions 2024-06, Vol.17 (11), p.1356 |
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| creator | Ortega-Paz, Luis Bor, Wilbert Franchi, Francesco van den Broek, Wout W A Rollini, Fabiana Giordano, Salvatore Galli, Mattia Been, Latonya Ghanem, Ghussan Shalhoub, Awss Garabedian, Haroutioun Al Saleh, Tala Uzunoglu, Ekin Zhou, Xuan Rivas, Andrea Pineda, Andres M Suryadevara, Siva Soffer, Daniel Mahowald, Madeline K Choi, Calvin Y Zenni, Martin M Phoenix, Fladia Ajjan, Ramzi A Ten Berg, Jurrien M Angiolillo, Dominick J |
| description | Among patients treated with a novel oral anticoagulant (NOAC) undergoing percutaneous coronary intervention (PCI), combination therapy with clopidogrel (ie, known as dual antithrombotic therapy [DAT]) is the treatment of choice. However, there are concerns for individuals with impaired response to clopidogrel.
The authors sought to assess the pharmacodynamic (PD) effects of clopidogrel vs low-dose ticagrelor in patients with impaired clopidogrel response assessed by the ABCD-GENE score.
This was a prospective, randomized PD study of NOAC-treated patients undergoing PCI. Patients with an ABCD-GENE score ≥10 (n = 39), defined as having impaired clopidogrel response, were randomized to low-dose ticagrelor (n = 20; 60 mg twice a day) or clopidogrel (n = 19; 75 mg once a day). Patients with an ABCD-GENE score |
| doi_str_mv | 10.1016/j.jcin.2024.03.027 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed</sourceid><recordid>TN_cdi_pubmed_primary_38597172</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>38597172</sourcerecordid><originalsourceid>FETCH-pubmed_primary_385971723</originalsourceid><addsrcrecordid>eNqFjs1OAjEURhsTA6i8gAtzX2Bq24EpuJtMNLpyIiSGFSlDgTsZWuyPCYkPw7PwZDZG166-xTk5-Qi55Yxyxov7lrYNGiqYGFGWUybkBRnwiSwyWbBxn1x53zJWsKkUPdLPJ-Op5FIMyFctFsAFvJgdrjCgNYAGahVQm-DhTX9EdGi28OpUdz6VJmBj1TZ26sctN0E7qLVrYlBG2-jPp8o6a5Q7pmaCn6mTzAeY7zTM3ss6K6tMwCzE9fGGXG5U5_Xwd6_J3dPjvHrODnG11-vlweE-hZZ_d_N_hW8WyFMZ</addsrcrecordid><sourcetype>Index Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>P2Y 12 Inhibition in Patients Requiring Oral Anticoagulation After Percutaneous Coronary Intervention: The SWAP-AC-2 Study</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Ortega-Paz, Luis ; Bor, Wilbert ; Franchi, Francesco ; van den Broek, Wout W A ; Rollini, Fabiana ; Giordano, Salvatore ; Galli, Mattia ; Been, Latonya ; Ghanem, Ghussan ; Shalhoub, Awss ; Garabedian, Haroutioun ; Al Saleh, Tala ; Uzunoglu, Ekin ; Zhou, Xuan ; Rivas, Andrea ; Pineda, Andres M ; Suryadevara, Siva ; Soffer, Daniel ; Mahowald, Madeline K ; Choi, Calvin Y ; Zenni, Martin M ; Phoenix, Fladia ; Ajjan, Ramzi A ; Ten Berg, Jurrien M ; Angiolillo, Dominick J</creator><creatorcontrib>Ortega-Paz, Luis ; Bor, Wilbert ; Franchi, Francesco ; van den Broek, Wout W A ; Rollini, Fabiana ; Giordano, Salvatore ; Galli, Mattia ; Been, Latonya ; Ghanem, Ghussan ; Shalhoub, Awss ; Garabedian, Haroutioun ; Al Saleh, Tala ; Uzunoglu, Ekin ; Zhou, Xuan ; Rivas, Andrea ; Pineda, Andres M ; Suryadevara, Siva ; Soffer, Daniel ; Mahowald, Madeline K ; Choi, Calvin Y ; Zenni, Martin M ; Phoenix, Fladia ; Ajjan, Ramzi A ; Ten Berg, Jurrien M ; Angiolillo, Dominick J</creatorcontrib><description>Among patients treated with a novel oral anticoagulant (NOAC) undergoing percutaneous coronary intervention (PCI), combination therapy with clopidogrel (ie, known as dual antithrombotic therapy [DAT]) is the treatment of choice. However, there are concerns for individuals with impaired response to clopidogrel.
The authors sought to assess the pharmacodynamic (PD) effects of clopidogrel vs low-dose ticagrelor in patients with impaired clopidogrel response assessed by the ABCD-GENE score.
This was a prospective, randomized PD study of NOAC-treated patients undergoing PCI. Patients with an ABCD-GENE score ≥10 (n = 39), defined as having impaired clopidogrel response, were randomized to low-dose ticagrelor (n = 20; 60 mg twice a day) or clopidogrel (n = 19; 75 mg once a day). Patients with an ABCD-GENE score <10 (n = 42) were treated with clopidogrel (75 mg once a day; control cohort). PD assessments at baseline and 30 days post-randomization (trough and peak) were performed to assess P2Y
signaling (VerifyNow P2Y
reaction units [PRU], light transmittance aggregometry, and vasodilator-stimulated phosphoprotein); makers of thrombosis not specific to P2Y
signaling were also assessed. The primary endpoint was PRU (trough levels) at 30 days.
At 30 days, PRU levels were reduced with ticagrelor-based DAT compared with clopidogrel-based DAT at trough (23.0 [Q1-Q3: 3.0-46.0] vs 154.5 [Q1-Q3: 77.5-183.0]; P < 0.001) and peak (6.0 [Q1-Q3: 4.0-14.0] vs 129.0 [Q1-Q3: 66.0-171.0]; P < 0.001). Trough PRU levels in the control arm (104.0 [Q1-Q3: 35.0-167.0]) were higher than ticagrelor-based DAT (P = 0.005) and numerically lower than clopidogrel-based DAT (P = 0.234). Results were consistent by light transmittance aggregometry and vasodilator-stimulated phosphoprotein. Markers measuring other pathways leading to thrombus formation were largely unaffected.
In NOAC-treated patients undergoing PCI with an ABCD-GENE score ≥10, ticagrelor-based DAT using a 60-mg, twice-a-day regimen reduced platelet P2Y
reactivity compared with clopidogrel-based DAT. (Tailoring P2Y12 Inhibiting Therapy in Patients Requiring Oral Anticoagulation After PCI [SWAP-AC-2]; NCT04483583).</description><identifier>EISSN: 1876-7605</identifier><identifier>DOI: 10.1016/j.jcin.2024.03.027</identifier><identifier>PMID: 38597172</identifier><language>eng</language><publisher>United States</publisher><subject>Administration, Oral ; Aged ; Anticoagulants - administration & dosage ; Anticoagulants - adverse effects ; Blood Platelets - drug effects ; Blood Platelets - metabolism ; Cell Adhesion Molecules - blood ; Clopidogrel - administration & dosage ; Clopidogrel - adverse effects ; Coronary Artery Disease - blood ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - therapy ; Drug Resistance ; Dual Anti-Platelet Therapy - adverse effects ; Female ; Humans ; Male ; Microfilament Proteins - blood ; Microfilament Proteins - genetics ; Middle Aged ; Percutaneous Coronary Intervention - adverse effects ; Phosphoproteins - blood ; Platelet Aggregation - drug effects ; Platelet Aggregation Inhibitors - administration & dosage ; Platelet Aggregation Inhibitors - adverse effects ; Platelet Function Tests ; Prospective Studies ; Purinergic P2Y Receptor Antagonists - administration & dosage ; Purinergic P2Y Receptor Antagonists - adverse effects ; Receptors, Purinergic P2Y12 - blood ; Receptors, Purinergic P2Y12 - drug effects ; Ticagrelor - administration & dosage ; Ticagrelor - adverse effects ; Time Factors ; Treatment Outcome</subject><ispartof>JACC. Cardiovascular interventions, 2024-06, Vol.17 (11), p.1356</ispartof><rights>Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27907,27908</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38597172$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ortega-Paz, Luis</creatorcontrib><creatorcontrib>Bor, Wilbert</creatorcontrib><creatorcontrib>Franchi, Francesco</creatorcontrib><creatorcontrib>van den Broek, Wout W A</creatorcontrib><creatorcontrib>Rollini, Fabiana</creatorcontrib><creatorcontrib>Giordano, Salvatore</creatorcontrib><creatorcontrib>Galli, Mattia</creatorcontrib><creatorcontrib>Been, Latonya</creatorcontrib><creatorcontrib>Ghanem, Ghussan</creatorcontrib><creatorcontrib>Shalhoub, Awss</creatorcontrib><creatorcontrib>Garabedian, Haroutioun</creatorcontrib><creatorcontrib>Al Saleh, Tala</creatorcontrib><creatorcontrib>Uzunoglu, Ekin</creatorcontrib><creatorcontrib>Zhou, Xuan</creatorcontrib><creatorcontrib>Rivas, Andrea</creatorcontrib><creatorcontrib>Pineda, Andres M</creatorcontrib><creatorcontrib>Suryadevara, Siva</creatorcontrib><creatorcontrib>Soffer, Daniel</creatorcontrib><creatorcontrib>Mahowald, Madeline K</creatorcontrib><creatorcontrib>Choi, Calvin Y</creatorcontrib><creatorcontrib>Zenni, Martin M</creatorcontrib><creatorcontrib>Phoenix, Fladia</creatorcontrib><creatorcontrib>Ajjan, Ramzi A</creatorcontrib><creatorcontrib>Ten Berg, Jurrien M</creatorcontrib><creatorcontrib>Angiolillo, Dominick J</creatorcontrib><title>P2Y 12 Inhibition in Patients Requiring Oral Anticoagulation After Percutaneous Coronary Intervention: The SWAP-AC-2 Study</title><title>JACC. Cardiovascular interventions</title><addtitle>JACC Cardiovasc Interv</addtitle><description>Among patients treated with a novel oral anticoagulant (NOAC) undergoing percutaneous coronary intervention (PCI), combination therapy with clopidogrel (ie, known as dual antithrombotic therapy [DAT]) is the treatment of choice. However, there are concerns for individuals with impaired response to clopidogrel.
The authors sought to assess the pharmacodynamic (PD) effects of clopidogrel vs low-dose ticagrelor in patients with impaired clopidogrel response assessed by the ABCD-GENE score.
This was a prospective, randomized PD study of NOAC-treated patients undergoing PCI. Patients with an ABCD-GENE score ≥10 (n = 39), defined as having impaired clopidogrel response, were randomized to low-dose ticagrelor (n = 20; 60 mg twice a day) or clopidogrel (n = 19; 75 mg once a day). Patients with an ABCD-GENE score <10 (n = 42) were treated with clopidogrel (75 mg once a day; control cohort). PD assessments at baseline and 30 days post-randomization (trough and peak) were performed to assess P2Y
signaling (VerifyNow P2Y
reaction units [PRU], light transmittance aggregometry, and vasodilator-stimulated phosphoprotein); makers of thrombosis not specific to P2Y
signaling were also assessed. The primary endpoint was PRU (trough levels) at 30 days.
At 30 days, PRU levels were reduced with ticagrelor-based DAT compared with clopidogrel-based DAT at trough (23.0 [Q1-Q3: 3.0-46.0] vs 154.5 [Q1-Q3: 77.5-183.0]; P < 0.001) and peak (6.0 [Q1-Q3: 4.0-14.0] vs 129.0 [Q1-Q3: 66.0-171.0]; P < 0.001). Trough PRU levels in the control arm (104.0 [Q1-Q3: 35.0-167.0]) were higher than ticagrelor-based DAT (P = 0.005) and numerically lower than clopidogrel-based DAT (P = 0.234). Results were consistent by light transmittance aggregometry and vasodilator-stimulated phosphoprotein. Markers measuring other pathways leading to thrombus formation were largely unaffected.
In NOAC-treated patients undergoing PCI with an ABCD-GENE score ≥10, ticagrelor-based DAT using a 60-mg, twice-a-day regimen reduced platelet P2Y
reactivity compared with clopidogrel-based DAT. (Tailoring P2Y12 Inhibiting Therapy in Patients Requiring Oral Anticoagulation After PCI [SWAP-AC-2]; NCT04483583).</description><subject>Administration, Oral</subject><subject>Aged</subject><subject>Anticoagulants - administration & dosage</subject><subject>Anticoagulants - adverse effects</subject><subject>Blood Platelets - drug effects</subject><subject>Blood Platelets - metabolism</subject><subject>Cell Adhesion Molecules - blood</subject><subject>Clopidogrel - administration & dosage</subject><subject>Clopidogrel - adverse effects</subject><subject>Coronary Artery Disease - blood</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - therapy</subject><subject>Drug Resistance</subject><subject>Dual Anti-Platelet Therapy - adverse effects</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Microfilament Proteins - blood</subject><subject>Microfilament Proteins - genetics</subject><subject>Middle Aged</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Phosphoproteins - blood</subject><subject>Platelet Aggregation - drug effects</subject><subject>Platelet Aggregation Inhibitors - administration & dosage</subject><subject>Platelet Aggregation Inhibitors - adverse effects</subject><subject>Platelet Function Tests</subject><subject>Prospective Studies</subject><subject>Purinergic P2Y Receptor Antagonists - administration & dosage</subject><subject>Purinergic P2Y Receptor Antagonists - adverse effects</subject><subject>Receptors, Purinergic P2Y12 - blood</subject><subject>Receptors, Purinergic P2Y12 - drug effects</subject><subject>Ticagrelor - administration & dosage</subject><subject>Ticagrelor - adverse effects</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1876-7605</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFjs1OAjEURhsTA6i8gAtzX2Bq24EpuJtMNLpyIiSGFSlDgTsZWuyPCYkPw7PwZDZG166-xTk5-Qi55Yxyxov7lrYNGiqYGFGWUybkBRnwiSwyWbBxn1x53zJWsKkUPdLPJ-Op5FIMyFctFsAFvJgdrjCgNYAGahVQm-DhTX9EdGi28OpUdz6VJmBj1TZ26sctN0E7qLVrYlBG2-jPp8o6a5Q7pmaCn6mTzAeY7zTM3ss6K6tMwCzE9fGGXG5U5_Xwd6_J3dPjvHrODnG11-vlweE-hZZ_d_N_hW8WyFMZ</recordid><startdate>20240610</startdate><enddate>20240610</enddate><creator>Ortega-Paz, Luis</creator><creator>Bor, Wilbert</creator><creator>Franchi, Francesco</creator><creator>van den Broek, Wout W A</creator><creator>Rollini, Fabiana</creator><creator>Giordano, Salvatore</creator><creator>Galli, Mattia</creator><creator>Been, Latonya</creator><creator>Ghanem, Ghussan</creator><creator>Shalhoub, Awss</creator><creator>Garabedian, Haroutioun</creator><creator>Al Saleh, Tala</creator><creator>Uzunoglu, Ekin</creator><creator>Zhou, Xuan</creator><creator>Rivas, Andrea</creator><creator>Pineda, Andres M</creator><creator>Suryadevara, Siva</creator><creator>Soffer, Daniel</creator><creator>Mahowald, Madeline K</creator><creator>Choi, Calvin Y</creator><creator>Zenni, Martin M</creator><creator>Phoenix, Fladia</creator><creator>Ajjan, Ramzi A</creator><creator>Ten Berg, Jurrien M</creator><creator>Angiolillo, Dominick J</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope></search><sort><creationdate>20240610</creationdate><title>P2Y 12 Inhibition in Patients Requiring Oral Anticoagulation After Percutaneous Coronary Intervention: The SWAP-AC-2 Study</title><author>Ortega-Paz, Luis ; Bor, Wilbert ; Franchi, Francesco ; van den Broek, Wout W A ; Rollini, Fabiana ; Giordano, Salvatore ; Galli, Mattia ; Been, Latonya ; Ghanem, Ghussan ; Shalhoub, Awss ; Garabedian, Haroutioun ; Al Saleh, Tala ; Uzunoglu, Ekin ; Zhou, Xuan ; Rivas, Andrea ; Pineda, Andres M ; Suryadevara, Siva ; Soffer, Daniel ; Mahowald, Madeline K ; Choi, Calvin Y ; Zenni, Martin M ; Phoenix, Fladia ; Ajjan, Ramzi A ; Ten Berg, Jurrien M ; Angiolillo, Dominick J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-pubmed_primary_385971723</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Administration, Oral</topic><topic>Aged</topic><topic>Anticoagulants - administration & dosage</topic><topic>Anticoagulants - adverse effects</topic><topic>Blood Platelets - drug effects</topic><topic>Blood Platelets - metabolism</topic><topic>Cell Adhesion Molecules - blood</topic><topic>Clopidogrel - administration & dosage</topic><topic>Clopidogrel - adverse effects</topic><topic>Coronary Artery Disease - blood</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - therapy</topic><topic>Drug Resistance</topic><topic>Dual Anti-Platelet Therapy - adverse effects</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Microfilament Proteins - blood</topic><topic>Microfilament Proteins - genetics</topic><topic>Middle Aged</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Phosphoproteins - blood</topic><topic>Platelet Aggregation - drug effects</topic><topic>Platelet Aggregation Inhibitors - administration & dosage</topic><topic>Platelet Aggregation Inhibitors - adverse effects</topic><topic>Platelet Function Tests</topic><topic>Prospective Studies</topic><topic>Purinergic P2Y Receptor Antagonists - administration & dosage</topic><topic>Purinergic P2Y Receptor Antagonists - adverse effects</topic><topic>Receptors, Purinergic P2Y12 - blood</topic><topic>Receptors, Purinergic P2Y12 - drug effects</topic><topic>Ticagrelor - administration & dosage</topic><topic>Ticagrelor - adverse effects</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ortega-Paz, Luis</creatorcontrib><creatorcontrib>Bor, Wilbert</creatorcontrib><creatorcontrib>Franchi, Francesco</creatorcontrib><creatorcontrib>van den Broek, Wout W A</creatorcontrib><creatorcontrib>Rollini, Fabiana</creatorcontrib><creatorcontrib>Giordano, Salvatore</creatorcontrib><creatorcontrib>Galli, Mattia</creatorcontrib><creatorcontrib>Been, Latonya</creatorcontrib><creatorcontrib>Ghanem, Ghussan</creatorcontrib><creatorcontrib>Shalhoub, Awss</creatorcontrib><creatorcontrib>Garabedian, Haroutioun</creatorcontrib><creatorcontrib>Al Saleh, Tala</creatorcontrib><creatorcontrib>Uzunoglu, Ekin</creatorcontrib><creatorcontrib>Zhou, Xuan</creatorcontrib><creatorcontrib>Rivas, Andrea</creatorcontrib><creatorcontrib>Pineda, Andres M</creatorcontrib><creatorcontrib>Suryadevara, Siva</creatorcontrib><creatorcontrib>Soffer, Daniel</creatorcontrib><creatorcontrib>Mahowald, Madeline K</creatorcontrib><creatorcontrib>Choi, Calvin Y</creatorcontrib><creatorcontrib>Zenni, Martin M</creatorcontrib><creatorcontrib>Phoenix, Fladia</creatorcontrib><creatorcontrib>Ajjan, Ramzi A</creatorcontrib><creatorcontrib>Ten Berg, Jurrien M</creatorcontrib><creatorcontrib>Angiolillo, Dominick J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><jtitle>JACC. Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ortega-Paz, Luis</au><au>Bor, Wilbert</au><au>Franchi, Francesco</au><au>van den Broek, Wout W A</au><au>Rollini, Fabiana</au><au>Giordano, Salvatore</au><au>Galli, Mattia</au><au>Been, Latonya</au><au>Ghanem, Ghussan</au><au>Shalhoub, Awss</au><au>Garabedian, Haroutioun</au><au>Al Saleh, Tala</au><au>Uzunoglu, Ekin</au><au>Zhou, Xuan</au><au>Rivas, Andrea</au><au>Pineda, Andres M</au><au>Suryadevara, Siva</au><au>Soffer, Daniel</au><au>Mahowald, Madeline K</au><au>Choi, Calvin Y</au><au>Zenni, Martin M</au><au>Phoenix, Fladia</au><au>Ajjan, Ramzi A</au><au>Ten Berg, Jurrien M</au><au>Angiolillo, Dominick J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>P2Y 12 Inhibition in Patients Requiring Oral Anticoagulation After Percutaneous Coronary Intervention: The SWAP-AC-2 Study</atitle><jtitle>JACC. Cardiovascular interventions</jtitle><addtitle>JACC Cardiovasc Interv</addtitle><date>2024-06-10</date><risdate>2024</risdate><volume>17</volume><issue>11</issue><spage>1356</spage><pages>1356-</pages><eissn>1876-7605</eissn><abstract>Among patients treated with a novel oral anticoagulant (NOAC) undergoing percutaneous coronary intervention (PCI), combination therapy with clopidogrel (ie, known as dual antithrombotic therapy [DAT]) is the treatment of choice. However, there are concerns for individuals with impaired response to clopidogrel.
The authors sought to assess the pharmacodynamic (PD) effects of clopidogrel vs low-dose ticagrelor in patients with impaired clopidogrel response assessed by the ABCD-GENE score.
This was a prospective, randomized PD study of NOAC-treated patients undergoing PCI. Patients with an ABCD-GENE score ≥10 (n = 39), defined as having impaired clopidogrel response, were randomized to low-dose ticagrelor (n = 20; 60 mg twice a day) or clopidogrel (n = 19; 75 mg once a day). Patients with an ABCD-GENE score <10 (n = 42) were treated with clopidogrel (75 mg once a day; control cohort). PD assessments at baseline and 30 days post-randomization (trough and peak) were performed to assess P2Y
signaling (VerifyNow P2Y
reaction units [PRU], light transmittance aggregometry, and vasodilator-stimulated phosphoprotein); makers of thrombosis not specific to P2Y
signaling were also assessed. The primary endpoint was PRU (trough levels) at 30 days.
At 30 days, PRU levels were reduced with ticagrelor-based DAT compared with clopidogrel-based DAT at trough (23.0 [Q1-Q3: 3.0-46.0] vs 154.5 [Q1-Q3: 77.5-183.0]; P < 0.001) and peak (6.0 [Q1-Q3: 4.0-14.0] vs 129.0 [Q1-Q3: 66.0-171.0]; P < 0.001). Trough PRU levels in the control arm (104.0 [Q1-Q3: 35.0-167.0]) were higher than ticagrelor-based DAT (P = 0.005) and numerically lower than clopidogrel-based DAT (P = 0.234). Results were consistent by light transmittance aggregometry and vasodilator-stimulated phosphoprotein. Markers measuring other pathways leading to thrombus formation were largely unaffected.
In NOAC-treated patients undergoing PCI with an ABCD-GENE score ≥10, ticagrelor-based DAT using a 60-mg, twice-a-day regimen reduced platelet P2Y
reactivity compared with clopidogrel-based DAT. (Tailoring P2Y12 Inhibiting Therapy in Patients Requiring Oral Anticoagulation After PCI [SWAP-AC-2]; NCT04483583).</abstract><cop>United States</cop><pmid>38597172</pmid><doi>10.1016/j.jcin.2024.03.027</doi></addata></record> |
| fulltext | fulltext |
| identifier | EISSN: 1876-7605 |
| ispartof | JACC. Cardiovascular interventions, 2024-06, Vol.17 (11), p.1356 |
| issn | 1876-7605 |
| language | eng |
| recordid | cdi_pubmed_primary_38597172 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Administration, Oral Aged Anticoagulants - administration & dosage Anticoagulants - adverse effects Blood Platelets - drug effects Blood Platelets - metabolism Cell Adhesion Molecules - blood Clopidogrel - administration & dosage Clopidogrel - adverse effects Coronary Artery Disease - blood Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - therapy Drug Resistance Dual Anti-Platelet Therapy - adverse effects Female Humans Male Microfilament Proteins - blood Microfilament Proteins - genetics Middle Aged Percutaneous Coronary Intervention - adverse effects Phosphoproteins - blood Platelet Aggregation - drug effects Platelet Aggregation Inhibitors - administration & dosage Platelet Aggregation Inhibitors - adverse effects Platelet Function Tests Prospective Studies Purinergic P2Y Receptor Antagonists - administration & dosage Purinergic P2Y Receptor Antagonists - adverse effects Receptors, Purinergic P2Y12 - blood Receptors, Purinergic P2Y12 - drug effects Ticagrelor - administration & dosage Ticagrelor - adverse effects Time Factors Treatment Outcome |
| title | P2Y 12 Inhibition in Patients Requiring Oral Anticoagulation After Percutaneous Coronary Intervention: The SWAP-AC-2 Study |
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