After acute coronary syndrome : the benefit of switching dual antiplatelet therapy

A randomized study has been led by the department of Coronary Disease and interventional Cardiology of Timone University Hospital (Marseille) on the TOPIC (timing of platelet inhibition after acute coronary syndrome).

Professor Thomas CUISSET (department of Coronary Disease and interventional Cardiology, in the service led by Professor Jean-Louis BONNET at the Timone University hospital of Marseille), presented this study in May 2017 at the EuroPCR2017, the World-Leading Course in Interventional Cardiovascular Medicine in Paris (France).

This study is published in the European Heart Journal.

« Newer P2Y12 blockers (prasugrel and ticagrelor) demonstrated significant ischaemic benefit over clopidogrel after acute coronary syndrome (ACS). However, both drugs are associated with an increase in bleeding complications », Pr CUISSET said. « The objective of the 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 ».

As a conclusion, « our data suggest that, in patients on aspirin plus ticagrelor or prasugrel without evidence of an adverse event in the first month following an ACS treated with PCI, switching DAPT strategy to aspirin plus clopidogrel may reduce the risk of bleeding recurrence without increased risk of ischaemic events. This finding is of major relevance to the ‘real-world’ management of ACS patients and offers an efficient and cost-effective alternative for ACS therapy particularly in those with a higher bleeding risk or drug compliance concerns. A future challenge will be to identify which patients would benefit from this switched DAPT strategy and which patients are best maintained on the more potent DAPT regimen for 1 year ».