In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
Abstract:
Introduction: Current clinical data have raised the issues regarding the risk of adverse events (e.g. bleeding and dyspnea) and the limited clinical benefit during ticagrelor vs. clopidogrel treatment in patients with acute coronary syndrome (ACS). Hypothesis: Association between bleeding and dyspnea during dual antiplatelet therapy (DAPT), and it would be related with drug switch or discontinuation. Methods: East Asian patients presented with ACS were undergoing percutaneous coronary intervention, and were treated with DPAT with ticagrelor (n=270) or clopidogrel (n=674). At 30-day follow-up, we evaluated platelet function with VerifyNow, and incidence of bleeding (BARC criteria) and dyspnea (MMRC scale) using the dedicated questionnaire. Results: During 30-day follow-up, ACS patients on ticagrelor showed the higher rates of bleeding (45.6% vs. 23.6%; HR, 2.71) and dyspnea (26.3% vs. 13.6%; HR, 2.25) compared with those on clopidogrel. In terms of low platelet reactivity (LPR), ticagrelor showed the lower cutoff (‘PRU≤20’) compared with clopidogrel (‘PRU≤110’). In multivariate analysis, LPR phenotype (OR, 2.70), not type of P2Y 12 inhibitor (OR, 1.34), was significantly associated with the risk of bleeding (Figure) . In addition, type of P2Y 12 inhibitor (OR, 2.14) and bleeding episode (OR, 2.83) increased the risk of dyspnea (Figure) . At 12-month follow-up, ticagrelor treatment showed a higher risk of drug discontinuation than clopidogrel treatment (27.8% vs. 4.7%; HR, 7.71). During ticagrelor administration, patients with both dyspnea and bleeding had a higher rate of drug discontinuation compared to those without both dyspnea and bleeding (adjusted HR, 3.05). Conclusions: This study suggests that incidence of bleeding and dyspnea was frequent during ticagrelor treatment in East Asian patients with ACS. A close association between bleeding and dyspnea increased the risk of drug discontinuation during ticagrelor treatment.
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.144.suppl_1.11965
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2021
detail.hit.zdb_id:
1466401-X
detail.hit.zdb_id:
80099-5
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