Key result
Ticagrelor levels >694.90 ng/mL linked to ~147% greater bleeding risk in ACS on DAPT.
Why the study?
This study evaluated the association between plasma concentrations of ticagrelor, ARC124910XX, aspirin, and salicylic acid and the risk of recent bleeding in patients with ACS to develop a bleeding prediction model.
Does plasma concentration of ticagrelor predict bleeding complications in Chinese ACS patients on dual antiplatelet therapy?
Observational (n=84)
Does plasma concentration of ticagrelor predict bleeding complications in Chinese ACS patients on dual antiplatelet therapy?
Odds Ratio: 2.47 (95% CI 1.51–4.75)
p-value: p=0.002
A ticagrelor plasma concentration >694.90 ng/mL independently predicts bleeding risk in Chinese ACS patients on dual antiplatelet therapy.
Plasma concentration-based bleeding model may refine DAPT safety in ACS; leaves open external validation before practice change.
PURPOSE: This study evaluated the association among the plasma concentration of ticagrelor, ARC124910XX, aspirin, and salicylic acid with the risk of recent bleeding in patients with the acute coronary syndrome. To this end, we developed an accurate model to predict bleeding. METHODS: A total of 84 patients included in this study cohort between May 2021 and November 2021. The risk factors were identified by univariate and multivariate analyses, and statistically significant risk factors identified in the multivariate analysis were included in the nomogram. We used the calibration curve and the receiver operating characteristic curve to verify the accuracy of the prediction model. RESULTS: Multivariable logistic analysis showed that ticagrelor concentration (odds ratio [OR]: 2.47, 95% confidence interval [CI], 1.51-4.75, P = 0.002), ST-segment elevation acute myocardial infarction (OR: 32.2, 95% CI, 2.37-780, P = 0.016), and lipid-lowering drugs (OR: 11.52, 95% CI, 1.91-110, P = 0.015) were positively correlated with bleeding. However, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (OR: 0.04, 95% CI, 0.004-0.213, P < 0.001) was negatively correlated with bleeding. The receiver operating characteristic curve analysis showed that ticagrelor concentration and these factors together predict the occurrence of bleeding (area under receiver operating characteristic curve = 0.945, 95% CI, 0.896-0.994) and that ticagrelor concentration >694.90 ng/mL is the threshold of bleeding concentration (area under receiver operating characteristic curve = 0.696, 95% CI, 0.558-0.834). CONCLUSION: In patients with acute coronary syndrome treated with dual antiplatelet therapy, ticagrelor concentration >694.90 ng/mL was an independent risk factor for bleeding (OR: 2.47, 95% CI, 1.51-4.75, P = 0.002), but ARC124910XX and salicylic acid concentration did not affect bleeding risk ( P > 0.05).
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Wang et al. (2023) conducted an observational in Acute coronary syndrome (n=84). Ticagrelor concentration >694.90 ng/mL was evaluated on Bleeding (OR 2.47, 95% CI 1.51-4.75, p=0.002). In patients with acute coronary syndrome on dual antiplatelet therapy, a ticagrelor concentration >694.90 ng/mL was an independent risk factor for bleeding (OR 2.47; 95% CI 1.51-4.75; P=0.002).
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