Safety and efficacy of low-dose ticagrelor in Chinese patients with acute coronary syndrome undergoing percutaneous coronary intervention.

Abstract

It remains unclear whether low-dose ticagrelor offers better safety and similar efficacy for Asian patients with acute coronary syndromes (ACS). We aimed to compare the safety and effectiveness of low-dose ticagrelor vs standard-dose ticagrelor in Chinese patients with ACS undergoing percutaneous coronary intervention (PCI). In this observational cohort study, a total of 2110 ACS patients who were event-free at 3 months after the index PCI were divided into standard-dose ticagrelor (90 mg twice daily) (n = 1830) or low-dose ticagrelor (45 mg twice daily) (n = 280) on a background of aspirin 100 mg once daily for at least another 9 months. The primary end point was type 2, 3, or 5 bleeding according to the Bleeding Academic Research Consortium (BARC) criteria over a 1-year follow-up period post-PCI. Predictors of the primary end point were identified. Both Cox regression and propensity score matching analyses were used. The cumulative incidence of BARC type 2, 3, or 5 bleeding was lower in the low-dose ticagrelor group vs the standard-dose group either before (adjusted HR 0.24; 95% CI 0.07-0.77; p = .016) or after matching (HR 0.25; 95% CI 0.08-0.85; p = .026). A composite of cardiac death, myocardial infarction, or stroke was not significantly different between the two groups (0.4% vs 0.9%, respectively). By multivariate analysis, only low-dose ticagrelor was a protected predictor of BARC type 2, 3, or 5 bleeding either before (HR 0.28, 95% CI 0.09-0.89) or after matching (HR 0.24, 95% CI 0.07-0.82). A low-dose regimen of ticagrelor might provide better safety than standard-dose ticagrelor in Chinese patients with ACS undergoing PCI.

• Authors: Yue Wang, Beibei Liu, Leilei Chen, Yue Wang, Zhiqiang Wang, Xiaojiang Zhang, Min Suo, Gary S Mintz, Xiaofan Wu
• Journal: Platelets (Platelets) Vol. 33 Issue 2 Pg. 304-311 (Feb 17 2022) ISSN: 1369-1635 [Electronic] England
• PMID: 33813995 (Publication Type: Journal Article)

Chemical References

• Platelet Aggregation Inhibitors
• Ticagrelor

Topics

• Acute Coronary Syndrome (drug therapy)
• China
• Cohort Studies
• Female
• Humans
• Male
• Middle Aged
• Percutaneous Coronary Intervention (methods)
• Platelet Aggregation Inhibitors (pharmacology, therapeutic use)
• Prospective Studies
• Ticagrelor (pharmacology, therapeutic use)
• Treatment Outcome