TY - JOUR
T1 - Comparison of Ticagrelor Versus Clopidogrel on Cerebrovascular Microembolic Events and Platelet Inhibition during Transcatheter Aortic Valve Implantation
AU - Vavuranakis, Michael A.
AU - Kalantzis, Charalampos
AU - Voudris, Vassilis
AU - Kosmas, Elias
AU - Kalogeras, Konstantinos
AU - Katsianos, Efstratios
AU - Oikonomou, Evaggelos
AU - Siasos, Gerasimos
AU - Aznaouridis, Konstantinos
AU - Toutouzas, Konstantinos
AU - Stasinopoulou, Myrsini
AU - Tountopoulou, Argyro
AU - Bei, Evangelia
AU - Moldovan, Carmen M.
AU - Vrachatis, Dimitrios
AU - Iakovou, Ioannis
AU - Papaioannou, Theodore G.
AU - Tousoulis, Dimitrios
AU - Leucker, Thorsten M.
AU - Vavuranakis, Manolis
N1 - Funding Information:
Funding/Support: This work was supported by Astra Zeneca.
Publisher Copyright:
© 2021
PY - 2021/9/1
Y1 - 2021/9/1
N2 - The impact of the antiplatelet regimen and the extent of associated platelet inhibition on cerebrovascular microembolic events during transcatheter aortic valve implantation (TAVI) are unknown. Our aim was to evaluate the effects of ticagrelor versus clopidogrel and of platelet inhibition on the number of cerebrovascular microembolic events in patients undergoing TAVI. Patients scheduled for TAVI were randomized previous to the procedure to either aspirin and ticagrelor or to aspirin and clopidogrel. Platelet inhibition was expressed in P2Y12 reaction units (PRU) and percentage of inhibition. High intensity transient signals (HITS) were assessed with transcranial Doppler (TCD). Safety outcomes were recorded according to the VARC-2 definitions. Among 90 patients randomized, 6 had an inadequate TCD signal. The total number of procedural HITS was lower in the ticagrelor group (416.5 [324.8, 484.2]) (42 patients) than in the clopidogrel group (723.5 [471.5, 875.0]) (42 patients), p <0.001. After adjusting for the duration of the procedure, diabetes, extra-cardiac arteriopathy, BMI, hypertension, aortic valve calcium content, procedural ACT, and pre-implantation balloon valvuloplasty, patients on ticagrelor had on average 256.8 (95% CI: [-335.7, -176.5]) fewer total procedural HITS than patients on clopidogrel. Platelet inhibition was greater with ticagrelor 26 [10, 74.5] PRU than with clopidogrel 207.5 (120 to 236.2) PRU, p <0.001, and correlated significantly with procedural HITS (r = 0.5, p <0.05). In conclusion, ticagrelor resulted in fewer procedural HITS, compared with clopidogrel, in patients undergoing TAVI, while achieving greater platelet inhibition.
AB - The impact of the antiplatelet regimen and the extent of associated platelet inhibition on cerebrovascular microembolic events during transcatheter aortic valve implantation (TAVI) are unknown. Our aim was to evaluate the effects of ticagrelor versus clopidogrel and of platelet inhibition on the number of cerebrovascular microembolic events in patients undergoing TAVI. Patients scheduled for TAVI were randomized previous to the procedure to either aspirin and ticagrelor or to aspirin and clopidogrel. Platelet inhibition was expressed in P2Y12 reaction units (PRU) and percentage of inhibition. High intensity transient signals (HITS) were assessed with transcranial Doppler (TCD). Safety outcomes were recorded according to the VARC-2 definitions. Among 90 patients randomized, 6 had an inadequate TCD signal. The total number of procedural HITS was lower in the ticagrelor group (416.5 [324.8, 484.2]) (42 patients) than in the clopidogrel group (723.5 [471.5, 875.0]) (42 patients), p <0.001. After adjusting for the duration of the procedure, diabetes, extra-cardiac arteriopathy, BMI, hypertension, aortic valve calcium content, procedural ACT, and pre-implantation balloon valvuloplasty, patients on ticagrelor had on average 256.8 (95% CI: [-335.7, -176.5]) fewer total procedural HITS than patients on clopidogrel. Platelet inhibition was greater with ticagrelor 26 [10, 74.5] PRU than with clopidogrel 207.5 (120 to 236.2) PRU, p <0.001, and correlated significantly with procedural HITS (r = 0.5, p <0.05). In conclusion, ticagrelor resulted in fewer procedural HITS, compared with clopidogrel, in patients undergoing TAVI, while achieving greater platelet inhibition.
UR - http://www.scopus.com/inward/record.url?scp=85109432545&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85109432545&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2021.05.047
DO - 10.1016/j.amjcard.2021.05.047
M3 - Article
C2 - 34243938
AN - SCOPUS:85109432545
SN - 0002-9149
VL - 154
SP - 78
EP - 85
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -