Tags

Type your tag names separated by a space and hit enter

Evaluation of a Novel Antiplatelet Therapy Strategy in Patients Undergoing Elective Percutaneous Coronary Intervention.
J Pharm Pract. 2020 Jul 03 [Online ahead of print]JP

Abstract

BACKGROUND

Ticagrelor presents less thrombotic risk compared to clopidogrel in acute coronary syndromes. However, its role in dual antiplatelet therapy (DAPT)-naive patients with stable ischemic heart disease (SIHD) undergoing elective percutaneous intervention (PCI) remains unclear, including uncertainty in the method of conversion to clopidogrel for adequate coverage without increased bleeding risk.

OBJECTIVE

Determine the safety and efficacy of ticagrelor loading and transitioning to clopidogrel in patients with SIHD undergoing elective PCI.

METHODS

This is a retrospective cohort review of patients with SIHD who underwent elective PCI. The Switch Rx patients were treated with ticagrelor immediately before PCI, converted to clopidogrel 300 mg the day after, and discharged with clopidogrel 75 mg daily. Standard Rx patients, who received a clopidogrel load and received clopidogrel 75 mg daily after the procedure, were analyzed as a matched comparator cohort. The safety outcomes were any bleeding event at 24 hours and 30 days. The efficacy outcomes included major adverse cardiac events (MACE) at 24 hours and 30 days.

RESULTS

Five Switch Rx patients (n = 54) experienced bleeding academic research consortium type I bleeding within 24 hours, with no subsequent bleeding observed out to 30 days. When comparing the Switch Rx patients (n = 39) to their matched Standard Rx cohort (n = 39), no MACEs occurred within 30 days and there were no significant differences in safety and efficacy outcomes.

CONCLUSION

In DAPT-naive patients undergoing elective PCI for SIHD, a strategy of in-lab ticagrelor transitioning to clopidogrel with a 300-mg load was not associated with increased bleeding or other adverse events.

Authors+Show Affiliations

Department of Pharmacy Services, VA San Diego Healthcare System, San Diego, CA, USA. Skaggs School of Pharmacy and Pharmaceutical Sciences, VA San Diego, University of California, San Diego, CA, USA.Department of Pharmacy Services, VA San Diego Healthcare System, San Diego, CA, USA.Computational Arrhythmia Research Laboratory, Department of Medicine, Stanford University, Stanford, CA, USA.Department of Pharmacy Services, VA San Diego Healthcare System, San Diego, CA, USA. Skaggs School of Pharmacy and Pharmaceutical Sciences, VA San Diego, University of California, San Diego, CA, USA.Division of Cardiology, VA San Diego Healthcare System, San Diego, CA, USA. School of Medicine, University of California, San Diego, CA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32618225

Citation

Giang, Kayla, et al. "Evaluation of a Novel Antiplatelet Therapy Strategy in Patients Undergoing Elective Percutaneous Coronary Intervention." Journal of Pharmacy Practice, 2020, p. 897190020933469.
Giang K, Stallings HE, Clopton P, et al. Evaluation of a Novel Antiplatelet Therapy Strategy in Patients Undergoing Elective Percutaneous Coronary Intervention. J Pharm Pract. 2020.
Giang, K., Stallings, H. E., Clopton, P., Stubbs, M. K., & Penny, W. F. (2020). Evaluation of a Novel Antiplatelet Therapy Strategy in Patients Undergoing Elective Percutaneous Coronary Intervention. Journal of Pharmacy Practice, 897190020933469. https://doi.org/10.1177/0897190020933469
Giang K, et al. Evaluation of a Novel Antiplatelet Therapy Strategy in Patients Undergoing Elective Percutaneous Coronary Intervention. J Pharm Pract. 2020 Jul 3;897190020933469. PubMed PMID: 32618225.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of a Novel Antiplatelet Therapy Strategy in Patients Undergoing Elective Percutaneous Coronary Intervention. AU - Giang,Kayla, AU - Stallings,Holly E, AU - Clopton,Paul, AU - Stubbs,Maria K, AU - Penny,William F, Y1 - 2020/07/03/ PY - 2020/7/4/entrez KW - clopidogrel KW - percutaneous coronary intervention KW - pharmacotherapy KW - stable ischemic heart disease KW - ticagrelor SP - 897190020933469 EP - 897190020933469 JF - Journal of pharmacy practice JO - J Pharm Pract N2 - BACKGROUND: Ticagrelor presents less thrombotic risk compared to clopidogrel in acute coronary syndromes. However, its role in dual antiplatelet therapy (DAPT)-naive patients with stable ischemic heart disease (SIHD) undergoing elective percutaneous intervention (PCI) remains unclear, including uncertainty in the method of conversion to clopidogrel for adequate coverage without increased bleeding risk. OBJECTIVE: Determine the safety and efficacy of ticagrelor loading and transitioning to clopidogrel in patients with SIHD undergoing elective PCI. METHODS: This is a retrospective cohort review of patients with SIHD who underwent elective PCI. The Switch Rx patients were treated with ticagrelor immediately before PCI, converted to clopidogrel 300 mg the day after, and discharged with clopidogrel 75 mg daily. Standard Rx patients, who received a clopidogrel load and received clopidogrel 75 mg daily after the procedure, were analyzed as a matched comparator cohort. The safety outcomes were any bleeding event at 24 hours and 30 days. The efficacy outcomes included major adverse cardiac events (MACE) at 24 hours and 30 days. RESULTS: Five Switch Rx patients (n = 54) experienced bleeding academic research consortium type I bleeding within 24 hours, with no subsequent bleeding observed out to 30 days. When comparing the Switch Rx patients (n = 39) to their matched Standard Rx cohort (n = 39), no MACEs occurred within 30 days and there were no significant differences in safety and efficacy outcomes. CONCLUSION: In DAPT-naive patients undergoing elective PCI for SIHD, a strategy of in-lab ticagrelor transitioning to clopidogrel with a 300-mg load was not associated with increased bleeding or other adverse events. SN - 1531-1937 UR - https://www.unboundmedicine.com/medline/citation/32618225/Evaluation_of_a_Novel_Antiplatelet_Therapy_Strategy_in_Patients_Undergoing_Elective_Percutaneous_Coronary_Intervention L2 - https://journals.sagepub.com/doi/10.1177/0897190020933469?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.