Optimization of antiplatelet therapy in patients with coronary artery disease and type 2 diabetes mellitus after percutaneous coronary interventions

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Dual antiplatelet therapy (DAP) with clopidogrel and aspirin after percutaneous coronary interventions (PCI) in patients with chronic coronary syndrome (CCS) are mainly used to prevent stent thrombosis and restenosis. Despite the use of approved doses of the antiplatelet, major adverse cardiac events (MACE) frequently occur in short and mid-term period in patients with type 2 diabetes mellitus (T2DM) and CCS. Aim of the study was to evaluate the efficacy of ticagrelol in patients with CCS and T2DM after elective PCI. Material and Methods The prospective, open label randomized study with 112 patients with CCS and T2DM who admitted for the elective PCI were enrolled in the study from 2018 to 2022 (aged 49-72 years, mean age 59.2±12.2 years, male 52%). Patients were divided into two groups by 56 via open randomization. Group I patients were assigned ticagrelol 90 mg BID after the loading dose of 180 mg ticagrelol along with standard dose of aspirin for 1 year whereas Group II were assigned clopidogrel along with aspirin for 1 year. 20 µmoll ADP induced platelet aggregation was assessed at baseline and after the 12 hours of administering loading dose of antiplatelet. Efficacy and safely were assessed during the follow up in both group of patients. All statistical analysis were performed using STATA software. Results Inhibition of platelet aggregation (IPA) with 20 µmoll ADP at 12 hours was significantly higher in ticagrelol group than clopidogrel group (71.65±14.25% vs. 42.74±18.25%, P<0.001). During the maintenance dose, IPA with 20 µmoll ADP at 48 hours was significantly higher in ticagrelol group than clopidogrel group (68.12±13.27% vs. 45.82±17.54%, P<0.001). PCI bleeding complications were similar in each group and there was not observed any statistically significant changes (P>0.05). During the mean follow-up period ticagrelol group tended to have higher bleeding than clopidogrel group, however they were not observed any statistically significant changes (log-rank test; 0.752). Pertaining to MACE, ticagrelol group tended to have lesser MACE than clopidogrel group, (Mantel–Cox test; P=0.045). 56 ticagrelol treated patients showed that MACE tended to be negatively associated with post PCI bleeding complications (P=0.048). Conclusions Dual antiplatelet therapy with ticagrelol and aspirin is superior than clopidogrel plus aspirin to prevent MACE in patients with chronic coronary syndrome and type 2 diabetes mellitus after elective percutaneous coronary interventions. However, ticagrelol should be used cautiously in patients with gastrointestinal ulcers due to its PCI related bleeding risks.