DAPT Plus Cilostazol is Better Than Traditional DAPT or Aspirin Plus Ticagrelor as Elective PCI for Intermediate-to-Highly Complex Cases

Prospective, Randomized, PRU-Based Study in Taiwan

Yueh Chung Chen, Feng Yen Lin, Yi Wen Lin, Shu Meng Cheng, Rong Ho Lin, Chun Ling Chuang, Jehn Shing Sheu, Shan Min Chen, Chao Chien Chang, Chien Sung Tsai

研究成果: 雜誌貢獻文章

摘要

Purpose: Current treatment guidelines do not recommend different antiplatelet treatments for patients in different coronary risk categories; nor do they consider ethnic differences in responses to individual drugs. Objectives: We performed a prospective, single-blind, randomized, comparative study of Taiwanese patients with stable angina and scheduled stent implantation for intermediate-to-highly complex coronary lesions and compared the platelet reactivity unit (PRU) levels and 24-month outcomes of groups receiving three different antiplatelet treatments. Methods: Patients (N = 334) were randomized into three treatment groups (aspirin + clopidogrel, aspirin + ticagrelor, or aspirin + clopidogrel + cilostazol) for 6 months of treatment and were then switched to aspirin only. PRU levels were determined 24 h, 7 days, and 1 month after stent implantation. Clinical outcomes and adverse events were recorded over 24 months. Results: Clopidogrel treatment reached full effect after 1 month. Ticagrelor decreased PRU levels more than did clopidogrel but often to levels that increased the risk of hemorrhage. The addition of cilostazol to clopidogrel decreased PRU levels earlier and more strongly than clopidogrel alone but not as strongly as did ticagrelor. Ticagrelor treatment caused fewer major adverse cardiovascular events (MACEs) and more episodes of minor bleeding than the other two treatments. Conclusions: Clopidogrel appears safer than ticagrelor in Taiwanese patients with stable angina after stent implantation for intermediate-to-highly complex coronary lesions. The addition of cilostazol to clopidogrel may provide a more rapid decrease in PRU to therapeutic levels without increasing the risk of hemorrhage. Clinical trial registration number: NCT02101411.
原文英語
頁(從 - 到)75-86
頁數12
期刊American Journal of Cardiovascular Drugs
19
發行號1
DOIs
出版狀態已發佈 - 二月 12 2019

指紋

clopidogrel
Taiwan
Aspirin
Blood Platelets
Stents
Therapeutics
Stable Angina
Hemorrhage
Ticagrelor
cilostazol

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

引用此文

DAPT Plus Cilostazol is Better Than Traditional DAPT or Aspirin Plus Ticagrelor as Elective PCI for Intermediate-to-Highly Complex Cases : Prospective, Randomized, PRU-Based Study in Taiwan. / Chen, Yueh Chung; Lin, Feng Yen; Lin, Yi Wen; Cheng, Shu Meng; Lin, Rong Ho; Chuang, Chun Ling; Sheu, Jehn Shing; Chen, Shan Min; Chang, Chao Chien; Tsai, Chien Sung.

於: American Journal of Cardiovascular Drugs, 卷 19, 編號 1, 12.02.2019, p. 75-86.

研究成果: 雜誌貢獻文章

Chen, Yueh Chung ; Lin, Feng Yen ; Lin, Yi Wen ; Cheng, Shu Meng ; Lin, Rong Ho ; Chuang, Chun Ling ; Sheu, Jehn Shing ; Chen, Shan Min ; Chang, Chao Chien ; Tsai, Chien Sung. / DAPT Plus Cilostazol is Better Than Traditional DAPT or Aspirin Plus Ticagrelor as Elective PCI for Intermediate-to-Highly Complex Cases : Prospective, Randomized, PRU-Based Study in Taiwan. 於: American Journal of Cardiovascular Drugs. 2019 ; 卷 19, 編號 1. 頁 75-86.
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title = "DAPT Plus Cilostazol is Better Than Traditional DAPT or Aspirin Plus Ticagrelor as Elective PCI for Intermediate-to-Highly Complex Cases: Prospective, Randomized, PRU-Based Study in Taiwan",
abstract = "Purpose: Current treatment guidelines do not recommend different antiplatelet treatments for patients in different coronary risk categories; nor do they consider ethnic differences in responses to individual drugs. Objectives: We performed a prospective, single-blind, randomized, comparative study of Taiwanese patients with stable angina and scheduled stent implantation for intermediate-to-highly complex coronary lesions and compared the platelet reactivity unit (PRU) levels and 24-month outcomes of groups receiving three different antiplatelet treatments. Methods: Patients (N = 334) were randomized into three treatment groups (aspirin + clopidogrel, aspirin + ticagrelor, or aspirin + clopidogrel + cilostazol) for 6 months of treatment and were then switched to aspirin only. PRU levels were determined 24 h, 7 days, and 1 month after stent implantation. Clinical outcomes and adverse events were recorded over 24 months. Results: Clopidogrel treatment reached full effect after 1 month. Ticagrelor decreased PRU levels more than did clopidogrel but often to levels that increased the risk of hemorrhage. The addition of cilostazol to clopidogrel decreased PRU levels earlier and more strongly than clopidogrel alone but not as strongly as did ticagrelor. Ticagrelor treatment caused fewer major adverse cardiovascular events (MACEs) and more episodes of minor bleeding than the other two treatments. Conclusions: Clopidogrel appears safer than ticagrelor in Taiwanese patients with stable angina after stent implantation for intermediate-to-highly complex coronary lesions. The addition of cilostazol to clopidogrel may provide a more rapid decrease in PRU to therapeutic levels without increasing the risk of hemorrhage. Clinical trial registration number: NCT02101411.",
author = "Chen, {Yueh Chung} and Lin, {Feng Yen} and Lin, {Yi Wen} and Cheng, {Shu Meng} and Lin, {Rong Ho} and Chuang, {Chun Ling} and Sheu, {Jehn Shing} and Chen, {Shan Min} and Chang, {Chao Chien} and Tsai, {Chien Sung}",
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T2 - Prospective, Randomized, PRU-Based Study in Taiwan

AU - Chen, Yueh Chung

AU - Lin, Feng Yen

AU - Lin, Yi Wen

AU - Cheng, Shu Meng

AU - Lin, Rong Ho

AU - Chuang, Chun Ling

AU - Sheu, Jehn Shing

AU - Chen, Shan Min

AU - Chang, Chao Chien

AU - Tsai, Chien Sung

PY - 2019/2/12

Y1 - 2019/2/12

N2 - Purpose: Current treatment guidelines do not recommend different antiplatelet treatments for patients in different coronary risk categories; nor do they consider ethnic differences in responses to individual drugs. Objectives: We performed a prospective, single-blind, randomized, comparative study of Taiwanese patients with stable angina and scheduled stent implantation for intermediate-to-highly complex coronary lesions and compared the platelet reactivity unit (PRU) levels and 24-month outcomes of groups receiving three different antiplatelet treatments. Methods: Patients (N = 334) were randomized into three treatment groups (aspirin + clopidogrel, aspirin + ticagrelor, or aspirin + clopidogrel + cilostazol) for 6 months of treatment and were then switched to aspirin only. PRU levels were determined 24 h, 7 days, and 1 month after stent implantation. Clinical outcomes and adverse events were recorded over 24 months. Results: Clopidogrel treatment reached full effect after 1 month. Ticagrelor decreased PRU levels more than did clopidogrel but often to levels that increased the risk of hemorrhage. The addition of cilostazol to clopidogrel decreased PRU levels earlier and more strongly than clopidogrel alone but not as strongly as did ticagrelor. Ticagrelor treatment caused fewer major adverse cardiovascular events (MACEs) and more episodes of minor bleeding than the other two treatments. Conclusions: Clopidogrel appears safer than ticagrelor in Taiwanese patients with stable angina after stent implantation for intermediate-to-highly complex coronary lesions. The addition of cilostazol to clopidogrel may provide a more rapid decrease in PRU to therapeutic levels without increasing the risk of hemorrhage. Clinical trial registration number: NCT02101411.

AB - Purpose: Current treatment guidelines do not recommend different antiplatelet treatments for patients in different coronary risk categories; nor do they consider ethnic differences in responses to individual drugs. Objectives: We performed a prospective, single-blind, randomized, comparative study of Taiwanese patients with stable angina and scheduled stent implantation for intermediate-to-highly complex coronary lesions and compared the platelet reactivity unit (PRU) levels and 24-month outcomes of groups receiving three different antiplatelet treatments. Methods: Patients (N = 334) were randomized into three treatment groups (aspirin + clopidogrel, aspirin + ticagrelor, or aspirin + clopidogrel + cilostazol) for 6 months of treatment and were then switched to aspirin only. PRU levels were determined 24 h, 7 days, and 1 month after stent implantation. Clinical outcomes and adverse events were recorded over 24 months. Results: Clopidogrel treatment reached full effect after 1 month. Ticagrelor decreased PRU levels more than did clopidogrel but often to levels that increased the risk of hemorrhage. The addition of cilostazol to clopidogrel decreased PRU levels earlier and more strongly than clopidogrel alone but not as strongly as did ticagrelor. Ticagrelor treatment caused fewer major adverse cardiovascular events (MACEs) and more episodes of minor bleeding than the other two treatments. Conclusions: Clopidogrel appears safer than ticagrelor in Taiwanese patients with stable angina after stent implantation for intermediate-to-highly complex coronary lesions. The addition of cilostazol to clopidogrel may provide a more rapid decrease in PRU to therapeutic levels without increasing the risk of hemorrhage. Clinical trial registration number: NCT02101411.

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