Safety and efficacy of low-dose ticagrelor in Chinese patients with acute coronary syndrome undergoing percutaneous coronary intervention

• Published in: Platelets (Edinburgh) Vol. 33; no. 2; pp. 304 - 311
• Main Authors: Wang, Yue, Liu, Beibei, Chen, Leilei, Wang, Zhiqiang, Zhang, Xiaojiang, Suo, Min, Mintz, Gary S., Wu, Xiaofan
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 17.02.2022; Taylor & Francis Group
• Subjects: acute coronary syndrome; Acute Coronary Syndrome - drug therapy; China; Cohort Studies; Female; Humans; low-dose ticagrelor; Male; Middle Aged; percutaneous coronary intervention; Percutaneous Coronary Intervention - methods; Platelet Aggregation Inhibitors - pharmacology; Platelet Aggregation Inhibitors - therapeutic use; Prospective Studies; safety; Ticagrelor - pharmacology; Ticagrelor - therapeutic use; Treatment Outcome; China; percutaneous coronary intervention; acute coronary syndrome; low-dose ticagrelor; safety
• ISSN: 0953-7104; 1369-1635
• DOI: 10.1080/09537104.2021.1909717

It remains unclear whether low-dose ticagrelor offers better safety and similar efficacy for Asian patients with acute coronary syndromes (ACS). We aimed to compare the safety and effectiveness of low-dose ticagrelor vs standard-dose ticagrelor in Chinese patients with ACS undergoing percutaneous coronary intervention (PCI). In this observational cohort study, a total of 2110 ACS patients who were event-free at 3 months after the index PCI were divided into standard-dose ticagrelor (90 mg twice daily) (n = 1830) or low-dose ticagrelor (45 mg twice daily) (n = 280) on a background of aspirin 100 mg once daily for at least another 9 months. The primary end point was type 2, 3, or 5 bleeding according to the Bleeding Academic Research Consortium (BARC) criteria over a 1-year follow-up period post-PCI. Predictors of the primary end point were identified. Both Cox regression and propensity score matching analyses were used. The cumulative incidence of BARC type 2, 3, or 5 bleeding was lower in the low-dose ticagrelor group vs the standard-dose group either before (adjusted HR 0.24; 95% CI 0.07-0.77; p = .016) or after matching (HR 0.25; 95% CI 0.08-0.85; p = .026). A composite of cardiac death, myocardial infarction, or stroke was not significantly different between the two groups (0.4% vs 0.9%, respectively). By multivariate analysis, only low-dose ticagrelor was a protected predictor of BARC type 2, 3, or 5 bleeding either before (HR 0.28, 95% CI 0.09-0.89) or after matching (HR 0.24, 95% CI 0.07-0.82). A low-dose regimen of ticagrelor might provide better safety than standard-dose ticagrelor in Chinese patients with ACS undergoing PCI.