• NEWS . 12 Oct 2020
  • Higher WBC counts linked to worse clinical outcomes among post-PCI patients receiving ticagrelor monotherapy

  • Increased white blood cell (WBC) counts, which may reflect degree of inflammation, at the time of index procedure may attenuate the anti-ischaemic effects of ticagrelor monotherapy observed in patients with lower WBC counts.

    This is according to a post-hoc analysis of the GLOBAL LEADERS trial, a multicentre, open-label, randomized all-comer trial in patients undergoing percutaneous coronary intervention (PCI), comparing the experimental strategy (23-month ticagrelor monotherapy after 1-month dual anti-platelet therapy [DAPT]) versus the reference strategy (12-month aspirin monotherapy after 12-month DAPT). Patients were stratified into two WBC groups, either lower or higher, defined as < or ≥ median WBC count of 7.8 × 109 cells/L, respectively. The primary endpoint was a composite of all-cause mortality or new Q-wave myocardial infarction at 2 years.

    Results showed that out of the 14,576 patients included, 7,212 patients (49.5%) were classified as the lower WBC group, who had a significantly lower risk of both ischaemic and bleeding outcomes at 2 years. At 2 years, the experimental strategy resulted in a significantly lower incidence of the primary endpoint compared with the reference strategy in the lower WBC group (2.8% vs 4.2%; hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.52–0.86), but not in the higher WBC group (4.8% vs 4.7%; HR, 1.01; 95% CI, 0.82–1.25). No significant differences were found in the risks of BARC (Bleeding Academic Research Consortium) type 3 or 5 bleeding between two antiplatelet strategies, irrespective of WBC group.

    Reference: 
    Ono M, et al. Impact of white blood cell count on clinical outcomes in patients treated with aspirin-free ticagrelor monotherapy after percutaneous coronary intervention: Insights from the GLOBAL LEADERS trial. Eur Heart J Cardiovasc Pharmacother 2020. doi: 10.1093/ehjcvp/pvaa110. [Epub ahead of print].