Comparison of Antiplatelet Effect of Ticagrelor vs Tirofiban in Patients With Non-ST Elevation Acute Coronary Syndrome

Launched by PUSAN NATIONAL UNIVERSITY YANGSAN HOSPITAL · Aug 7, 2012

Keywords

ClinConnect Summary

In combination with aspirin, P2Y12 receptor antagonist or glycoprotein IIb/IIIa inhibitor(GPI) is now a recommended drug as the standard dual antiplatelet regimen in patients with acute coronary syndrome(1).

Ticagrelor is a newly developed oral P2Y12 receptor inhibitor. It shows faster, greater and more consistent platelet inhibition as compared with previous P2Y12 receptor antagonist clopidogrel(2) and it also shows better clinical outcome and similar risk for bleeding as compared with clopidogrel(3).Interestingly, pharmacodynamic data of some studies showed excellent effect of ticagrelor...

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Eligibility criteria

• Inclusion Criteria:
• • Patients with recent or current ischemic symptoms at the time of randomization will be eligible if 2 of the following criteria are met: ST-T change indicating ischemia; a positive test of biomarker indication myocardial necrosis; or one of several risk factors(age ≥60 years
• • Previous myocardial infarction or coronary artery bypass grafting \[CABG\]
• • Coronary artery disease with stenosis of ≥50% in at least two vessels
• • Previous ischemic stroke, transient ischemic attack, carotid stenosis of at least 50%, or cerebral revascularization
• • Diabetes mellitus
• • Peripheral arterial disease; or chronic renal dysfunction, defined as a creatinine clearance of \<60 ml per minute per 1.73 m2 of body surface area)
• Exclusion Criteria:
• • 1. Administration of fibrinolytic or any GP IIb/IIIa inhibitors for the treatment of current AMI
• • 2. Major surgery or trauma within 30 days
• • 3. Active bleeding
• • 4. Previous stroke in the last six months
• • 5. Oral anticoagulant therapy
• • 6. Pre-existing thrombocytopenia
• • 7. Vasculitis
• • 8. Hypertensive retinopathy
• • 9. Severe hepatic failure
• • 10. Severe renal failure requiring hemodialysis
• • 11. Documented allergy/intolerance or contraindication to tirofiban or P2Y12 inhibitor
• • 12. Uncontrolled hypertension (systolic or diastolic arterial pressure \>180 mmHg or 120, respectively, despite medical therapy)
• • 13. Limited life expectancy, e.g. neoplasms, others
• • 14. Inability to obtain informed consent