Pharmacodynamic Effects of Switching From Ticagrelor to Clopidogrel in Patients With Coronary Artery Disease: Results of the SWAP-4 Study
Primary result · P2Y12 reaction unitsResult — go to the resultLeast mean difference −6.9 95% CI −38.1 to 24.3Authors' conclusion
De-escalation from ticagrelor to clopidogrel therapy is associated with an increase in platelet reactivity. The use of an LD before the initiation of an MD regimen of clopidogrel mitigates these observations, although this is not affected by the timing of its administration after ticagrelor discontinuation.
Study context
- Population
- Patients with CAD on aspirin and clopidogrel MD, after 7-day ticagrelor run-in
- Participants
- 80 patients
- Comparison
- De-escalation from ticagrelor to clopidogrel vs continued ticagrelor
- Primary endpoint
- P2Y12 reaction units (VerifyNow), C-600 mg-24h vs C-75 mg-24h
- Follow-up
- 48 hours
Methodological detailsprospective, open-label, pharmacodynamic study
- Prospective
- Open-label
- Pharmacodynamic study
Primary result
P2Y12 reaction units
Least mean difference
−6.9
95% CI −38.1 to 24.3
P = 0.66
C-600 mg-24hvs C-75 mg-24h
least mean difference −6.9 (95% CI −38.1 to 24.3); P = 0.66
As reported in the abstract
Further findings
| Outcome | P value |
|---|---|
| P2Y12 reaction units over timeC-600 mg-12h vs C-75 mg-24h · lower with C-600 mg-12h | P = 0.024 |
| Maximal platelet aggregation (LTA) over timeC-600 mg-24h vs C-75 mg-24h · lower with C-600 mg-24h | P = 0.041 |
| Maximal platelet aggregation (LTA) over timeC-600 mg-12h vs C-75 mg-24h · lower with C-600 mg-12h | P = 0.028 |
P2Y12 reaction units over time
- T-90 mg twice daily led to lower platelet reactivity than any clopidogrel regimen, all assays, all time points
Platelet reactivity index (VASP); C-600 mg-24h vs C-600 mg-12h, all tests
- Platelet reactivity index paralleled P2Y12 reaction units
- No pharmacodynamic differences between C-600 mg-24h and C-600 mg-12h
Platelet reactivity vs baseline in C-75 mg-24h
- Increased from 24 h, significant at 48 and 72 h and up to 10 days; delayed and blunted with an LD regardless of timing
Original publication
Pharmacodynamic Effects of Switching From Ticagrelor to Clopidogrel in Patients With Coronary Artery Disease: Results of the SWAP-4 Study. Circulation. Published 11 March 2018. doi:10.
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