Kim Laeun, Choe Jeong Cheon, Ahn Jin Hee, Lee Hye Won, Oh Jun-Hyok, Choi Jung Hyun, Lee Han Cheol, Cha Kwang Soo, Hong Taek Jong, Jeong Young-Hoon, Park Jin Sup
Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan 49241, Korea.
Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju 52727, Korea.
J Clin Med. 2021 Mar 10;10(6):1159. doi: 10.3390/jcm10061159.
To assess the temporal trends of bleeding episodes during half- vs. standard-dose ticagrelor in acute coronary syndrome (ACS) patients with low platelet reactivity (LPR) during standard-dose ticagrelor (90 mg bid). ACS Patients with LPR (<85 P2Y reaction units) ( = 122) were randomly assigned to receive either half-dose (45 mg bid) or standard-dose ticagrelor (90 mg bid). The primary endpoint was incidence of Bleeding Academic Research Consortium (BARC) bleeding at 1 week, 1, 3 and 6 months. Dyspnea and ischemic events were also evaluated. Bleeding episodes were most commonly observed at 1 month and then decreased over time. Half-dose ticagrelor did not reduce any BARC bleeding (odds ratio [OR] 0.900, 95% confidence interval [CI] 0.563-1.440, = 0.661). However, serious bleeding (BARC type ≥2) occurred less often in half-dose ticagrelor (OR 0.284, 95% CI 0.088-0.921, = 0.036). The rate of moderate-to-severe dyspnea was highest at 1 month, then decreased over time. Half-dose ticagrelor did not decrease moderate-to-severe dyspnea (Borg scale ≥ 3) (OR 1.066, 95% CI 0.322-3.530, = 0.916). The risk of ischemic events was also similar between the groups. In conclusions, compared with standard-dose ticagrelor, half-dose ticagrelor reduced serious bleeding events during early period of dual-antiplatelet therapy in ACS patients with LPR; however, the risk of any bleeding events and dyspnea did not differ according to ticagrelor dose. Clinical registration: KCT0004640.
为评估在标准剂量替格瑞洛（90毫克，每日两次）治疗期间血小板反应性低（LPR）的急性冠状动脉综合征（ACS）患者中，半剂量与标准剂量替格瑞洛治疗时出血事件的时间趋势。将LPR（<85个P2Y反应单位）的ACS患者（n = 122）随机分配接受半剂量（45毫克，每日两次）或标准剂量替格瑞洛（90毫克，每日两次）治疗。主要终点是1周、1、3和6个月时出血学术研究联盟（BARC）出血的发生率。还评估了呼吸困难和缺血事件。出血事件最常见于1个月时，然后随时间减少。半剂量替格瑞洛未减少任何BARC出血（比值比[OR] 0.900，95%置信区间[CI] 0.563 - 1.440，P = 0.661）。然而，半剂量替格瑞洛治疗时严重出血（BARC≥2型）的发生频率较低（OR 0.284，95% CI 0.088 - 0.921，P = 0.036）。中重度呼吸困难的发生率在1个月时最高，然后随时间下降。半剂量替格瑞洛未降低中重度呼吸困难（Borg量表≥3）（OR 1.066，95% CI 0.322 - 3.530，P = 0.916）。两组之间缺血事件的风险也相似。总之，与标准剂量替格瑞洛相比，半剂量替格瑞洛在LPR的ACS患者双联抗血小板治疗早期减少了严重出血事件；然而，任何出血事件和呼吸困难的风险并未因替格瑞洛剂量而有所不同。临床注册号：KCT0004640。
