Thromb Haemost 2017; 117(02): 303-310
DOI: 10.1160/TH16-04-0340
Cellular Haemostasis and Platelets
Schattauer GmbH

A randomised study for optimising crossover from ticagrelor to clopidogrel in patients with acute coronary syndrome

The CAPITAL OPTI-CROSS Study[*]
Ali Pourdjabbar
1  Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
,
Benjamin Hibbert
1  Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
,
Aun-Yeong Chong
1  Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
,
Michel R. Le May
1  Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
,
Marino Labinaz
1  Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
,
Trevor Simard
1  Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
,
F. Daniel Ramirez
1  Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
,
Peter Lugomirski
1  Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
,
Ronnen Maze
1  Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
,
Michael Froeschl
1  Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
,
Christopher Glover
1  Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
,
Alexander Dick
1  Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
,
Jean-Francois Marquis
1  Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
,
Jordan Bernick
2  Cardiovascular Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
,
George Wells
2  Cardiovascular Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
,
Derek Y. F. So
1  Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
,
the CAPITAL Investigators› Author Affiliations
Further Information

Publication History

Received:11 May 2016

Accepted after major revision:30 September 2016

Publication Date:
01 December 2017 (online)

Summary

Ticagrelor has been endorsed by guidelines as the P2Y12 inhibitor of choice in patients with acute coronary syndrome. Clinically, some patients on ticagrelor will require a switch to clopidogrel; however, the optimal strategy and pharmacodynamics effects of switching remain unknown. Patients with an indication to switch were randomly assigned to either a bolus arm (Clopidogrel 600 mg bolus followed by 75 mg daily, n=30) or a no-bolus arm (Clopidogrel 75 mg daily, n=30). Blood samples were collected at baseline, 12, 24, 48, 54, 60 and 72 hours (h) for assessment of platelet reactivity. The primary outcome was P2Y12 reactivity units (PRU) at 72 h. Secondary outcomes included: PRUs at each time point, incidence of high on-treatment platelet reactivity (HPR), major adverse cardiac events (MACE) and TIMI bleeding at 30 days. Serial PRUs increased after switching to clopidogrel in both groups. At 72 h, no difference in PRU was observed (165.8 ± 71.0 vs 184.1 ± 67.7, bolus vs no bolus, respectively, p=0.19). At 48 h the PRUs were significantly lower in the bolus arm (114 ± 73.1 vs 165.1 ± 70.5, respectively; p=0.0076) and at 72 h, there was a significant reduction in incidence of HPR (26.7 % vs 56.7 %, p=0.02). No differences in MACE or TIMI bleeding were observed. Although a bolus strategy was not associated with improved platelet inhibition at 72 h; at 48 h, platelet inhibition was superior with reduced incidence of HPR. Larger studies will be required to determine its clinical significance. Until then, decision for giving a bolus of clopidogrel at the time of a switch may in part be dependent on the indication for switching, especially if there are concerns for bleeding risk.

Supplementary Material to this article is available online at www.thrombosis-online.com.

* Clinicaltrials.gov NCT02054663.