Effect of Low-Dose Versus Standard-Dose Ticagrelor and Clopidogrel on Platelet Inhibition in Acute Coronary Syndromes

• Published in: Journal of the American College of Cardiology 2018-04, Vol.71 (14), p.1594-1595
• Main Authors: Park, Duk-Woo, Lee, Pil Hyung, Jang, Seongsoo, Lim, Hyeong-Seok, Kang, Do-Yoon, Lee, Cheol Hyun, Ahn, Jung-Min, Yun, Sung-Cheol, Park, Seong-Wook, Park, Seung-Jung
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - drug therapy; Acute Coronary Syndrome - metabolism; Acute coronary syndromes; Angina pectoris; Antiplatelet therapy; Cardiology; Clopidogrel; Clopidogrel - administration & dosage; Clopidogrel - pharmacokinetics; Dose-Response Relationship, Drug; Drug Therapy, Combination; Health risk assessment; Heart attacks; Humans; Platelet Aggregation Inhibitors - administration & dosage; Purinergic P2Y Receptor Antagonists - administration & dosage; Ticagrelor - administration & dosage; Ticagrelor - pharmacokinetics; Treatment Outcome
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2018.02.010

Because of different risk profiles and genetic backgrounds, East Asian populations are regarded as more susceptible to bleeding events but relatively resistant to atherothrombosis compared with Western populations (the so-called “East Asian paradox”) (1). [...]we sought to determine whether the relative safety and efficacy margin with the more potent P2Y12 antagonist (i.e., ticagrelor or prasugrel) is identical between Asian and Western patients with acute coronary syndrome (ACS). The OPTIMA (Optimal anti-Platelet Therapy In Management of Asian patients with acute coronary syndromes) trial was a prospective, single-center, randomized, parallel-group study involving patients >18 years of age with ACS (either unstable angina or acute myocardial infarction [MI]) who were P2Y12 antagonist-naïve within the past 6 months (NCT02319941). To detect an absolute mean difference of 60 ± 65 PRU 8 h after loading and at 30 days during maintenance of low-dose ticagrelor versus clopidogrel, which was assumed based on prior research (2,3), we estimated that 60 patients in total (20 in each group) were required to reach statistical significance with a power of 80%, a 2-sided α value of 0.05, and an attrition rate of 5%.