Benefit of switching dual antiplatelet therapy after acute coronary syndrome: The TOPIC (Timing Of Platelet Inhibition after acute Coronary Syndrome) randomized study - 05/01/18
, J. Quilci 1, 2, C. Bassez 1, G. Bonnet 3, M. Lambert 1, L. Fourcade 4, P.E. Morange 1, M.C. Alessi 1, J. Bonnet 5, T. Cuisset 1Résumé |
Background |
Newer P2Y12 blockers (prasugrel and ticagrelor) demonstrated significant ischemic benefit over clopidogrel after acute coronary syndrome (ACS). However, both drugs are associated with an increase in bleeding complications.
Purpose |
The objective of the present study was to evaluate the benefit of switching dual antiplatelet therapy (DAPT) from aspirin plus a newer P2Y12 blocker to aspirin plus clopidogrel 1 month after ACS.
Methods |
We performed an open-label, monocentric, randomized trial. From March 2014 to April 2016, patients admitted with ACS requiring coronary intervention, on aspirin and a newer P2Y12 blocker and without adverse event at 1 month, were assigned to switch to aspirin and clopidogrel (switched DAPT) or continuation of their drug regimen (unchanged DAPT). The primary outcome was a composite of cardiovascular death, urgent revascularization, stroke and bleeding as defined by the BARC classification≥2 at 1 year post-ACS.
Results |
Six hundred and forty-six patients were randomized and 645 analyzed, corresponding to 322 patients in the switched DAPT and 323 in the unchanged DAPT group. The primary endpoint occurred in 43 (13.4%) patients in the switched DAPT group and in 85 (26.3%) patients in the unchanged DAPT (HR 95% CI 0.48 (0.34–0.68), P<0.01) (Fig. 1). No significant differences were reported on ischemic endpoints, while BARC≥2 bleeding occurred in 13 (4.0%) patients in the switched DAPT and in 48 (14.9%) in the unchanged DAPT group (HR 95% CI 0.30 (0.18–0.50), P<0.01) (Fig. 1).
Conclusion |
A switched DAPT is superior to an unchanged DAPT strategy to prevent bleeding complications without increase in ischemic events following ACS.
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Vol 10 - N° 1
P. 19 - janvier 2018 Retour au numéro
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