Abstract
To assess the temporal trends of bleeding episodes during half- vs. standard-dose ticagrelor in acute coronary syndrome (ACS) patients with low platelet reactivity (LPR) during standard-dose ticagrelor (90 mg bid). ACS Patients with LPR (<85 P2Y12 reaction units) (n = 122) were randomly assigned to receive either half-dose (45 mg bid) or standard-dose ticagrelor (90 mg bid). The primary endpoint was incidence of Bleeding Academic Research Consortium (BARC) bleeding at 1 week, 1, 3 and 6 months. Dyspnea and ischemic events were also evaluated. Bleeding episodes were most commonly observed at 1 month and then decreased over time. Half-dose ticagrelor did not reduce any BARC bleeding (odds ratio [OR] 0.900, 95% confidence interval [CI] 0.563–1.440, p = 0.661). However, serious bleeding (BARC type ≥2) occurred less often in half-dose ticagrelor (OR 0.284, 95% CI 0.088–0.921, p = 0.036). The rate of moderate-to-severe dyspnea was highest at 1 month, then decreased over time. Half-dose ticagrelor did not decrease moderate-to-severe dyspnea (Borg scale ≥ 3) (OR 1.066, 95% CI 0.322–3.530, p = 0.916). The risk of ischemic events was also similar between the groups. In conclusions, compared with standard-dose ticagrelor, half-dose ticagrelor reduced serious bleeding events during early period of dual-antiplatelet therapy in ACS patients with LPR; however, the risk of any bleeding events and dyspnea did not differ according to ticagrelor dose. Clinical registration: KCT0004640.
Highlights
Dual antiplatelet therapy (DAPT) is an essential treatment in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) for at least12 months
Asian population exhibits the so-called “East Asian Paradox” [6], where East Asian patients are more vulnerable to bleeding events and relatively resistant to ischemic events during antithrombotic treatment compared to Caucasian patients
The study was performed in accordance with the principles established in the Declaration of Helsinki [14], and informed consent was obtained from all enrolled patients
Summary
Dual antiplatelet therapy (DAPT) is an essential treatment in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) for at least12 months. Dual antiplatelet therapy (DAPT) is an essential treatment in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) for at least. Current guidelines [1,2] recommend the use of a potent P2Y12 receptor inhibitor as a standard treatment for ACS patients [3,4]. These potent inhibitors are associated with a reduction in ischemic events and an increase in bleeding events. Asian population exhibits the so-called “East Asian Paradox” [6], where East Asian patients are more vulnerable to bleeding events and relatively resistant to ischemic events during antithrombotic treatment compared to Caucasian patients. Finding an optimal balance between risk and benefit is a challenging issue
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