TCT-153 Comparison of effect that ticagrelor and triple antiplatelet therapy affect platelet reactivity

Abstract

Background: High platelet reactivity (HPR) is associated with poor prognosis in coronary artery disease. Recently PLATO subgroup analysis showed that ticagrelor is better clinical outcome than the clopidogrel,whichwas relatedwith lowHPR.Alsomany studies reported that adjunctive cilostazol to dual antiplatelet therapy (DAPT) (so called triple antiplatelet therapy; TAT) is better clinical outcome than DAPT, which was associated with a greater antiplatelet effect at 30 days. Thus, this study was designed to compare the effect of ticagrelor and TAT on platelet reactivity with PRU and ARU values. Methods: This study was composed of total 65 patients underwent the coronary stenting. All patients received a 600-mg loading dose of clopidogrel or a 180-mg loading dose of ticagrelor and concomitant aspirin therapy. After patients underwent coronary stenting, theywere nonrandomly assigned to 1 of 4 groups:DAPT group (n1⁄415), clopidogrel of 75 mg daily; ticagrelor group (n1⁄420), ticagrelor of 180 mg daily; TAT group (n1⁄415), adjunctive cilostazol of 100mg twice daily to clopidogrel of 75mg daily; and triple switch group (n1⁄415), switch of ticagrelor to TAT since 3rd day. The platelet reactivity was assessed by ARU and PRU values at day 2 and day 7, respectively. Results: The average PRU value was lower in ticagrelor and TAT group than DAPT throughout the study period but the average ARU value did not differ among the 4 groups. The 2nd day average ARU was lower in the TAT group than ticagrelor group (405 vs. 510, p<0.01) and there was no significant difference on 7th day average ARU value. In ticagrelor group, 7th day average ARU is lower than 2th day ARU (458 vs. 510, p<0.05). Compared with TAT group, ticagrelor group had significantly lower PRU level at 2nd day and 7th day, respectively (91 vs. 162, p<0.05, 50 vs. 163, p<0.01). The 2nd day average PRU value of triple switch group was 70 which was similar to PRU of ticagrelor group and 7th day average PRU (151) was similar to that of TAT group. Conclusions: The ticagrelor and TAT therapy had the lower PRU level than DAPT and especially, ticagrelor showed the lowest incidence of HPR. This indicates that ticagrelor is more effective in HPR treatment than TAT.