title: Antiplatelet effect of ticagrelor compared to tirofiban in non-ST-segment elevation ACS patients undergoing PCI. The result of the TE-CLOT trial.
abstract: Addition of a potent P2Y12 inhibitor to aspirin is the standard therapy for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients undergoing percutaneous coronary intervention (PCI). Glycoprotein IIb/IIIa inhibitor, together with antiplatelet therapy, may be considered as part of initial therapy in NSTE-ACS patients with high-risk features. This study investigated the antiplatelet effect of ticagrelor loading dose (LD) versus tirofiban bolus injection with a post-bolus infusion on top of aspirin among NSTE-ACS patients planned to PCI. NSTE-ACS patients were randomised to receive either ticagrelor (n = 47) or tirofiban (n = 48). Platelet reactivity was assessed by light transmittance aggregometry at 0, 2, 8, and 24 hours (h) after treatment initiation. Primary endpoint was inhibition of platelet aggregation (IPA, 20 µM ADP, final extent) at 2 h after LD therapy, with a non-inferiority margin of 10%. The prevalence of high on-treatment platelet reactivity (HPR) was also compared at 0, 2, 8, and 24 h. The mean difference in IPA between ticagrelor and tirofiban was -9.9% (95% confidence interval: -25.7% to 5.9%) at 2 h, -1.6% (-8.0% to 4.8%) at 8 h, and -3.3% (-18.4% to 12.0%) at 24 h. The prevalence of HPR did not differ between the two groups at any time point (all p values ≥ 0.059), which was almost abolished by 8 h post-LD (< 5%). In conclusion, the antiplatelet effect during the early phase (~2 h) after ticagrelor LD appeared to be relatively strong, but it did not reach that of tirofiban in NSTE-ACS patients.
authors.forename: Jeong-Su
authors.initials: JS
authors.lastname: Kim
authors.forename: Dong-Cheul
authors.initials: DC
authors.lastname: Han
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Jeong
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.forename: Chang-Bae
authors.initials: CB
authors.lastname: Sohn
authors.forename: Ki-Won
authors.initials: KW
authors.lastname: Hwang
authors.forename: Sang-Hyun
authors.initials: SH
authors.lastname: Lee
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Choi
authors.forename: Min-Ku
authors.initials: MK
authors.lastname: Chon
authors.forename: Soo Yong
authors.initials: SY
authors.lastname: Lee
authors.forename: Jongmin
authors.initials: J
authors.lastname: Hwang
authors.forename: In-Suk
authors.initials: IS
authors.lastname: Kim
authors.forename: Sun-Min
authors.initials: SM
authors.lastname: Lee
authors.forename: Junhee
authors.initials: J
authors.lastname: Han
authors.forename: Maengseok
authors.initials: M
authors.lastname: Noh
authors.forename: Chang-Hoon
authors.initials: CH
authors.lastname: Kim
authors.forename: Kook Jin
authors.initials: KJ
authors.lastname: Chun
authors.forename: Yong Hyun
authors.initials: YH
authors.lastname: Park
authors.affiliation: Prof. June-Hong Kim, MD, PhD, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, 626-770 Korea, Tel.: +82 55 360 1457, Fax: +82 55 360 2204, E-mail: junehongkim@gmail.com.
authors.forename: June-Hong
authors.initials: JH
authors.lastname: Kim
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D010979:Platelet Function Tests; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D056910:Republic of Korea; D000077486:Ticagrelor; D013997:Time Factors; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D014443:Tyrosine; D000077466:Tirofiban; D000077486:Ticagrelor; D000241:Adenosine; D001241:Aspirin
keywords: Ticagrelor; non-ST-segment elevation acute coronary syndrome; percutaneous coronary intervention; tirofiban