Antiplatelet effect of ticagrelor compared to tirofiban in non-ST-segment elevation ACS patients undergoing PCI

Jeong-Su Kim; Dong-Cheul Han; Young-Hoon Jeong; Duk-Woo Park; Chang-Bae Sohn; Ki-Won Hwang; Sang-Hyun Lee; Jin Hee Choi; Min-Ku Chon; Soo Yong Lee; Jongmin Hwang; In-Suk Kim; Sun-Min Lee; Junhee Han; Maengseok Noh; Chang-Hoon Kim; Kook Jin Chun; Yong Hyun Park; June-Hong Kim

doi:10.1160/TH15-02-0180

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2016; 115(01): 213-221
DOI: 10.1160/TH15-02-0180

Atherosclerosis and Ischaemic Disease

Schattauer GmbH Schattauer

Antiplatelet effect of ticagrelor compared to tirofiban in non-ST-segment elevation ACS patients undergoing PCI

The result of the TE-CLOT trial

Jeong-Su Kim^*

¹Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

,

Dong-Cheul Han^*

¹Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

,

Young-Hoon Jeong

²Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea

,

Duk-Woo Park

³The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

,

Chang-Bae Sohn

¹Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

,

Ki-Won Hwang

¹Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

,

Sang-Hyun Lee

¹Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

,

Jin Hee Choi

¹Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

,

Min-Ku Chon

¹Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

,

Soo Yong Lee

¹Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

,

Jongmin Hwang

¹Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

,

In-Suk Kim

⁴Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea

,

Sun-Min Lee

⁴Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea

,

Junhee Han

⁵Research and Statistical Support, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

,

Maengseok Noh

⁶Department of Statistics, Pukyung National University, Busan, Korea

,

Chang-Hoon Kim

⁷Department of Preventive and Occupational Medicine, Pusan National University School of Medicine, Yangsan, Korea

,

Kook Jin Chun

¹Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

,

Yong Hyun Park

¹Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

,

June-Hong Kim

¹Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

› Author Affiliations

Abstract

Summary

Addition of a potent P2Y12 inhibitor to aspirin is the standard therapy for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients undergoing percutaneous coronary intervention (PCI). Glyco-protein IIb/IIIa inhibitor, together with antiplatelet therapy, may be considered as part of initial therapy in NSTE-ACS patients with high-risk features. This study investigated the antiplatelet effect of ticagrelor loading dose (LD) versus tirofiban bolus injection with a post-bolus infusion on top of aspirin among NSTE-ACS patients planned to PCI. NSTE-ACS patients were randomised to receive either ticagrelor (n = 47) or tirofiban (n = 48). Platelet reactivity was assessed by light transmittance aggregometry at 0, 2, 8, and 24 hours (h) after treatment initiation. Primary endpoint was inhibition of platelet aggregation (IPA, 20 µM ADP, final extent) at 2 h after LD therapy, with a non-inferiority margin of 10 %. The prevalence of high on-treatment platelet reactivity (HPR) was also compared at 0, 2, 8, and 24 h. The mean difference in IPA between ticagrelor and tirofiban was -9.9 % (95 % confidence interval: –25.7 % to 5.9 %) at 2 h, –1.6 % (-8.0 % to 4.8 %) at 8 h, and –3.3 % (-18.4 % to 12.0 %) at 24 h. The prevalence of HPR did not differ between the two groups at any time point (all p values ≥ 0.059), which was almost abolished by 8 h post-LD (< 5 %). In conclusion, the antiplatelet effect during the early phase (~2 h) after ticagrelor LD appeared to be relatively strong, but it did not reach that of tirofiban in NSTE-ACS patients.

Keywords

Ticagrelor - tirofiban - non-ST-segment elevation acute coronary syndrome - percutaneous coronary intervention

Full Text

References

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