Key result
Ticagrelor shows no significant increase in post-PTCA dyspnea over clopidogrel at 9 months.
Why the study?
Few studies had examined the incidence of dyspnea in post-PTCA ACS patients receiving dual antiplatelet therapy with aspirin and a P2Y12 inhibitor.
What is the incidence of dyspnea in post-PTCA patients receiving dual antiplatelet therapy?
Cohort (n=200)
No
What is the incidence of dyspnea in post-PTCA patients receiving dual antiplatelet therapy?
This study investigates the incidence of dyspnea as an adverse effect of dual antiplatelet therapy in post-PTCA patients.
Answers are grounded in this paper and cite their sources.
Should not yet change DAPT selection post-PTCA; leaves open the true comparative dyspnea risk of ticagrelor versus clopidogrel pending adequately powered cohorts.
Background: For post Percutaneous Transluminal Coronary Angioplasty for Acute Coronary Syndromes, Dual Antiplatelet Therapy with Aspirin and a P2Y12 receptor inhibitor like Ticagrelor or Clopidogrel is required minimum for a period of 12 months.There are few studies which have shown the incidence of dyspnea in patients receiving antiplatelet therapy.Methods: In this retrospective, single centre, cohort study, patients who underwent PTCA and were on dual antiplatelets were randomly selected from the clopidogrel and ticagrelor group between July 2013 and June 2014.Patient's relevant data were collected from electronic medical records and cross checked with manually maintained medical records wherever necessary.The study endpoint was incidence of dyspnoea within a follow up period of 9 months.Results: Among the 100 patients started on dual antiplatelet therapy with aspirin and ticagrelor, dyspnea occurred in 10% patients.Ticagrelor was substituted with clopidogrel in 60% cases.In 100 patients on clopidogrel, dyspnea occurred in 5% of patients, but clopidogrel was continued in all cases.Onset of dyspnea in patients on Ticagrelor occurred in 50% of patients in the first month of follow up, 10% cases at 3 months, 30% cases at 6 months and 10% cases at 9 months.But in clopidogrel group dyspnea occurred in 40% cases at 6 months follow up and 60% cases at 9 months.The p value on comparison of dyspnoea among the two groups was found to be 0.283, which was not statistically significant probably due to less sample population.Conclusion: Risk for dyspnoea induced by Ticagrelor was found to be higher than with Clopidogrel in the same ethnic groups when used as dual antiplatelet along with Aspirin.So it may not be a class effect or due to P2Y12 receptor inhibitory action alone.
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Krishnan et al. (2015) conducted a cohort in Post-percutaneous transluminal coronary angioplasty (PTCA) for acute coronary syndrome on dual antiplatelet therapy (n=200). Ticagrelor plus aspirin vs. Clopidogrel plus aspirin was evaluated on Incidence of dyspnea within 9 months of follow-up (p=0.283). Ticagrelor plus aspirin was associated with a 10% incidence of dyspnea over 9 months compared with 5% for clopidogrel plus aspirin in post-PTCA patients (p=0.283).
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