Efficacy and Safety of Loading Doses With P2Y12-Receptor Antagonists in Patients Without Dual Antiplatelet Therapy Undergoing Elective Coronary Intervention

Abstract

Background: European Guidelines on Myocardial Revascularization recommend clopidogrel loading dose added to acetylsalicylic acid in elective percutaneous coronary interventions (PCIs). However, there is few evidence supporting this recommendation and other P2Y12 inhibitors have not been tested in these patients. Purpose: To evaluate the effectiveness and safety of different loading doses of clopidogrel and ticagrelor in patients without double antiplatelet therapy and stable coronary artery disease (SCAD) undergoing elective PCI. Methods: Retrospective study of 147 consecutive patients with SCAD undergoing elective PCI. Loading P2Y12 inhibitor doses evaluated were: clopidogrel 600 mg, clopidogrel 300 mg, clopidogrel 150 mg, and ticagrelor 180 mg. We analyzed the occurrence of major adverse cardiovascular events and periprocedural myocardial infarction. Results: One hundred twenty-five patients were treated with clopidogrel (16 with clopidogrel 150 mg, 7 with clopidogrel 300 mg, and 93 with clopidogrel 600 mg) and 21 with ticagrelor 180 mg at the catheterization laboratory. The ticagrelor group had a significantly lower postprocedural peak of troponin-I (0.7 ± 3.4 vs. 0.3 ± 0.7 ng/mL; P = 0.02). There were no differences between groups in terms of major bleeding and hemoglobin drop after PCI (0.6 ± 0.8 vs. 4 ± 0.6; P = 0.8). The median of follow-up was 17 months (interquartile range 9–32.7). At the end of follow-up, major adverse cardiovascular event rate was not different between groups. Conclusions: In patients without dual antiplatelet therapy undergoing elective PCI, the use of ticagrelor showed lower postprocedural myocardial injury without more bleeding complications.

Efficacy and Safety of Ticagrelor and Clopidogrel in Patients with Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

“…Aggregometry studies have shown that prasugrel and ticagrelor have stronger antiplatelet effects than clopidogrel; however, the net clinical benefits of these new antiplatelet drugs in patients with SCAD (which may reduce ischemic events but not significantly increase bleeding ) have not yet been confirmed 40) . In addition, ticagrelor is used in patients with SCAD who receive PCI, and its use is increasing, especially in high-risk diabetic patients or in complex coronary artery disease 41) . This real-world study will provide important insight into the efficacy and safety of ticagrelor in patients with SCAD.…”

Increased risk of adverse events in patients with low-on clopidogrel platelet reactivity after percutaneous coronary intervention: A systematic review and meta-analysis

“…However, it also suggested that the administration of 600 mg LD of clopidogrel is associated with a lower risk of MACE [38]. This observation is further supported by a retrospective study of patients with stable coronary artery disease which shows no difference between different LD groups in terms of major bleeding and hemoglobin drop post PCI (39).…”

Loading doses of ticagrelor versus clopidogrel in preventing periprocedural myocardial infarction in Asian patients with acute coronary syndrome

“…Recently, a retrospective study showed that a loading dose of ticagrelor resulted in lower post-procedural myocardial injury with lesser bleeding complications among European patients with stable coronary disease undergoing elective PCI. 14 As we have mentioned above, previous studies have found that ticagrelor reduced myocardial injury or long-term adverse cardiovascular events after PCI. However, to the best of our knowledge, there was no randomized prospective study designed to compare ticagrelor versus clopidogrel in preventing PCI-related PMI among patients with ACS.…”

“…Recently, a retrospective study showed that a loading dose of ticagrelor resulted in lower post-procedural myocardial injury with lesser bleeding complications among European patients with stable coronary disease undergoing elective PCI. 14…”