Clémence Bassez

Benefit of switching dual antiplatelet therapy after acute coronary syndrome: the TOPIC (timing of platelet inhibition after acute coronary syndrome) randomized study.

Aims Newer P2Y12 blockers (prasugrel and ticagrelor) demonstrated significant ischaemic benefit over clopidogrel after acute coronary syndrome (ACS). However, both drugs are associated with an increase in bleeding complications. The objective of the present study was to evaluate the benefit of switching dual antiplatelet therapy (DAPT) from aspirin plus a newer P2Y12 blocker to aspirin plus clopidogrel 1 month after ACS. Methods and results We performed an open-label, monocentric, and randomized trial. From March 2014 to April 2016, patients admitted with ACS requiring coronary intervention, on aspirin and a newer P2Y12 blocker and without adverse event at 1 month, were assigned to switch to aspirin and clopidogrel (switched DAPT) or continuation of their drug regimen (unchanged DAPT). The primary outcome was a composite of cardiovascular death, urgent revascularization, stroke and bleeding as defined by the Bleeding Academic Research Consortium (BARC) classification ≥2 at 1 year post ACS. Six hundred and forty six patients were randomized and 645 analysed, corresponding to 322 patients in the switched DAPT and 323 in the unchanged DAPT group. The primary endpoint occurred in 43 (13.4%) patients in the switched DAPT group and in 85 (26.3%) patients in the unchanged DAPT (HR 95%CI 0.48 (0.34-0.68), P < 0.01). No significant differences were reported on ischaemic endpoints, while BARC ≥ 2 bleeding occurred in 13 (4.0%) patients in the switched DAPT and in 48 (14.9%) in the unchanged DAPT group (HR 95%CI 0.30 (0.18-0.50), P < 0.01). Conclusion A switched DAPT is superior to an unchanged DAPT strategy to prevent bleeding complications without increase in ischaemic events following ACS.

0230: Effectiveness of switching Prasugrel's ‘low responders’ to ticagrelor after acute coronary syndrome

Aims This study aimed to assess the effectiveness and safety of switching from Prasugrel to Ticagrelor patients identified as Prasugrel low-responders one month after ACS. Methods and results 540 patients admitted for ACS with coronary stent implantation and discharged on Prasugrel 10mg were screened. Prasugrel response was assessed one month after discharge using Platelet Reactivity Index Vasodilatator Stimulated Phosphoprotein (PRI VASP). High on-Treatment Platelet Reactivity (HTPR) was defined as VASP>50%. Patients with HTPR were enrolled and switched to Ticagrelor 90 mg twice a day. They were re-tested a month later. Primary endpoint was defined as: comparison of degree of platelet inhibition and incidence of HTPR one month after switching to Ticagrelor in patients with HTPR on Prasugrel therapy. The safety endpoint was the incidence of bleedings under Ticagrelor as compared with Prasugrel therapy, using the Bleeding Academic Research Consensus definition. Between March 2010 and November 2013, 19 patients were defined as HTPR on Prasugrel 10 mg one month after ACS, with a mean VASP of 59,3%. Among these patients, 14 were switched to Ticagrelor 180 mg daily and, at one month, we observed a significant decrease in PRI VASP, with a mean value at 19.6% (p Conclusion Switch to Ticagrelor in Prasugrels “low responders” patients is an effective strategy, leading to an adequate platelet inhibition in a large majority of patients. This biological tailored approach could be useful in preventing ischemic complications, in this specific high risk population, potentially increasing bleeding risk. This hypothesis needs to be confirmed in large clinical studies. Download : Download full-size image Abstract 0230 – Figure