P5544Antiplatelet effects of intraoperative administration of ticagrelor versus clopidogrel in patients undergoing one-stop hybrid coronary revascularization: a single-center randomized controlled trial

Abstract

Abstract Background “One-stop” hybrid coronary revascularization (HCR) has emerged to be a reliable and attractive alternative for selected patients with multivessel coronary artery disease. However, the optimal antiplatelet regimen of this procedure still remains controversial. Therefore, we conducted a randomized controlled trial to compare antiplatelet effect between ticagrelor and clopidogrel during this hybrid procedure. Purpose The study objective was to evaluate the onset of platelet inhibition between ticagrelor and clopidogrel in patients during “one-stop” HCR. Methods In a single-center, randomized, open-label study, 60 patients receiving one-stop HCR were randomized equally to received either clopidogrel (300 mg loading dose, 75 mg once per day), or ticagrelor (90 mg loading dose, 90 mg twice daily) after confirmation of LIMA-LAD graft patency. All patients treated with aspirin 100mg once daily during the treatment period. Platelet reaction units (PRU) was assessed by Verify Now™ P2Y12 assay before surgery; after confirmation of LIMA-LAD graft patency before administration study drugs; and at 30 minutes, 1 hour, 2 hours, 6 hours, 12 hours, 24 hours after loading dose. Major adverse cardiac events and bleeding events within a year follow-up were recorded. Results Ticagrelor produced further suppression of platelet aggregation in patients undergoing “one-stop” HCR from 2 hours after loading dose (PRU 271.0±51.6 vs 313.2±61.2, P=0.008). The average PRU value was still better at 24 hours after loading dose in the ticagrelor group than in the clopidogrel group (121.1±75.5 vs 284.3±67.0, P<0.001). There were no differences of bleeding or major adverse cardiac events between two groups. PRU value at various time points T C T vs C, P BS 272.7±48.5 275.5±60.4 0.842 BA 321.4±50.0 324.6±60.2 0.823 0.5 h 335.5±50.7 334.47±58.9 0.940 1 h 309.9±45.3 319.6±64.6 0.503 2 h 271.2±57.6 313.2±61.2 0.008 6 h 215.9±57.5 291.5±56.2 <0.001 12 h 196.9±80.1 295.4±62.8 <0.001 24 h 121.1±75.5 284.3±67.0 <0.001 PRU = platelet reation units; T = ticagrelor; C = clopidogrel; BS = before surgery; BA = before administration (after confrimation of left internal mammal artery graft patency). The trial flow diagram Conclusions In patients receiving “one-stop” HCR, the onset of action was fater and higher with ticagrelor than with clopidogrel. Acknowledgement/Funding This study was funded by AstraZeneca (China) Co, Ltd.