Antiplatelet effect of ticagrelor compared to tirofiban in non-ST-segment elevation ACS patients undergoing PCI The result of the TE-CLOT trial

초록

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-isk 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 mu M 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 (similar to 2 h) after ticagrelor LD appeared to be relatively strong, but it did not reach that of tirofiban in NSTE-ACS patients.

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