• NEWS . 27 Apr 2020
  • Optimal switching strategy from clopidogrel to ticagrelor for Chinese ACS patients managed by PCI

  • In Chinese acute coronary syndrome (ACS) patients with complicated coronary artery disease managed by percutaneous coronary intervention (PCI), the optimal treatment strategy recommended is 180 or 90 mg of ticagrelor 24 hours after the last dose of clopidogrel.

    This is according to the prospective, randomized, open-label SwitcHIng from clopidogrel to ticagrelor (SHIFT-CACS) study, which aimed to evaluate the optimal dose and time point for switching from clopidogrel to ticagrelor to balance the increase in platelet inhibition and the decrease in adverse events.

    Between July 2017 and December 2017, eligible Chinese ACS patients were assigned to treatment groups: 90 mg of ticagrelor at 12 hours (T-90 mg-12 h), 90 mg of ticagrelor at 24 hours (T-90 mg-24h) or 180 mg ticagrelor at 24 hours (T-180 mg-24 h) after the last dose of clopidogrel. The primary endpoint was the comparison of maximal platelet aggregation (MPA) values at 2 hours after switching strategies among the three groups, as analysed using a repeated-measures analysis of variance (ANOVA) model and one-way ANOVA.

    Results showed that MPA values were significantly decreased in the T-180 mg-24 h group compared with the T-90 mg-12 h group (p = 0.017), and decreased numerically compared with the T-90 mg-24 h group (p = 0.072) at 2 hours. In particular, MPA values were markedly lowered in the T-90 mg-24 h group compared with the T-90 mg-12 h group at 8 hours after switching treatment (p = 0.002). No significant differences were found among the three groups in any bleeding or dyspnoea events.

    Reference:
    Yao Y, et al. Optimal strategy of switching from clopidogrel to ticagrelor in Chinese acute coronary syndrome patients with complicated coronary artery disease: the switching from clopidogrel to ticagrelor (SHIFT-CACS) study. Chin Med J (Engl) 2019;132:2292-2299.