Thromb Haemost 2016; 115(01): 213-221
DOI: 10.1160/TH15-02-0180
Atherosclerosis and Ischaemic Disease
Schattauer GmbH Schattauer

Antiplatelet effect of ticagrelor compared to tirofiban in non-ST-segment elevation ACS patients undergoing PCI

The result of the TE-CLOT trial
Jeong-Su Kim*
1   Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
,
Dong-Cheul Han*
1   Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
,
Young-Hoon Jeong
2   Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
,
Duk-Woo Park
3   The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
,
Chang-Bae Sohn
1   Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
,
Ki-Won Hwang
1   Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
,
Sang-Hyun Lee
1   Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
,
Jin Hee Choi
1   Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
,
Min-Ku Chon
1   Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
,
Soo Yong Lee
1   Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
,
Jongmin Hwang
1   Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
,
In-Suk Kim
4   Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
,
Sun-Min Lee
4   Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
,
Junhee Han
5   Research and Statistical Support, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
,
Maengseok Noh
6   Department of Statistics, Pukyung National University, Busan, Korea
,
Chang-Hoon Kim
7   Department of Preventive and Occupational Medicine, Pusan National University School of Medicine, Yangsan, Korea
,
Kook Jin Chun
1   Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
,
Yong Hyun Park
1   Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
,
June-Hong Kim
1   Cardiovascular Center, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
› Author Affiliations
Financial support: This study was funded by AstraZeneca.
Further Information

Publication History

Received: 01 March 2015

Accepted after major revision: 21 July 2015

Publication Date:
22 November 2017 (online)

Summary

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). Glyco-protein 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.

* Jeong-Su Kim and Dong-Cheul Han contributed equally to this study.


 
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